泪道CT三维成像技术在鼻泪管阻塞中的应用

Implication of the lacrimal three-dimensional CT imaging technology in nasolacrimal duct obstruction surgery

目的探讨应用泪道CT三维成像技术指导泪道逆行置管手术治疗鼻泪管阻塞，以提高手术成功率。方法临床病例对照研究。对2012～2014年在深圳市人民医院眼科将鼻泪管阻塞患者分为置管组、高频电灼组及泪囊鼻腔吻合术组。置管组所有患者通过泪道CT三维成像技术测量骨性泪道的长度及最小直径。依据泪道长度〈13．9mm及最小直径〉3．1mm将患者分为3组：同时满足以上条件者为A组32例，满足其中之一者为B组35例，未达到以上条件者为C组37例。3组患者均行泪道逆行置管手术。高频电灼组31例行高频电灼泪道成形术，对照组39例采用泪囊鼻腔吻合术。结果A组患者手术治愈率为84．38％（27／32），与对照组相比较差异无统计学意义（x^2=0．459，P=0．499）。B组治愈率为62．86％（22／35），低于A组（x^2=3．939，P=0．047）。C组治愈率为56．76％（21／37），低于A组（r=6．182，P：O．013）。高频电灼组患者手术治愈率为58．06％（18／31），低于A组（x^2=5．341，P=0．021）。结论通过泪道CT三维成像技术选择泪道长度短、直径大的患者行泪道逆行置管术，可以有效提高手术成功率。

Objective To determine whether the lacrimal three-dimensional CT imaging technolo- gy can improve the success rate of nasolacrimal duct obstruction surgery. Methods One hundred and four patients were measured the length and the minimum diameter of bone lacrimal with the lac- rimal three-dimensional CT imaging technique. According to the length and the minimum diameter of the lacrimal duct, 104 patients were divided into three groups： 32 patients whose lacrimal duct was longer than 13.9mm and narrower than 3.1mm were in group A; 35 patients whose lacrimal duct was either longer than 13.9ram or narrower than 3.1ram were in group B. Other 37 patients were in group C. All of 104 patients underwent the retrograde lacrimal intubation. The 31 patients of the high-frequency electrocautery group underwent the high-frequency electrocautery. The 39 patients in control group underwent dacryocystorhinostomy. Results The cure rate of Group A was 84.38% （27/32）, and there was not significantly statistical difference （x^2=0.459,P =0.499） between Group A and the Control Group. The cure rate of Group B was 62.86% （22/35）, lower than Group A （x^2=3.939,P = 0.047）. The cure rate of Group C was 56.76% （21/37）, lower than Group A （x^2=6.182,P =0.013）. The cure rate of Group D was 58.06%（18/31）, lower than A group （x^2=5.341,P =0.021）. Conclusions Using lacrimal three-dimensional CT imaging technique can obviously improve the effect of surgery by choosing the patient with a short length and large diameter nasolacrimal duct.