鼻泪管解压术治疗慢性泪囊炎的影像学研究

The radiologic study of the nasolacrimal duct decompression surgery for treatment of chronic dacryocystitis

目的:探讨鼻内镜下鼻泪管解压术治疗慢性泪囊炎新术式的可行性。方法:1对22侧慢性泪囊炎患者给予30%碘海醇注射液进行泪囊造影,见造影剂从泪小管反流停止推药,立即进行泪道CT扫描;2应用Sinuses TracheaⅠ软件重建泪道及其周围结构三维可视图;3应用该软件对泪囊、鼻泪管进行模拟"切削"减压。结果:1泪道阻塞发生率分别是泪小管段4.5%(1/22)、泪囊段22.7%(5/22)、移行段13.6%(3/22)、鼻泪管段36.4%(8/22)、Hasner瓣段22.7%(5/22),其中移行段、鼻泪管段和Hasner瓣段占72.7%(16/22);2三维可视结构显示鼻泪管外侧壁是由上颌骨的泪沟构成,内壁由泪骨降突及下鼻甲的上行泪骨突构成;3从下鼻道观察,鼻泪管由下鼻甲骨围成,形成坚硬的鼻泪管及其开口内侧壁;4削去下鼻甲前端在鼻腔外侧壁的附着处即鼻泪管内侧壁,使膜鼻泪管得到充分开放,为解除鼻泪管阻塞创造可扩张空间。结论:鼻内镜下鼻泪管解压术治疗慢性泪囊炎具有可行性,且保留了膜性泪道完整性,避免了因切开泪囊肉芽增生、瘢痕形成导致泪道再次阻塞等并发症。

Objective：To explore the possibility of endoscopic nasolacrimal duct decompression surgery for the treatment of chronic dacryocystitis. Method： ①Twenty-two eyes with chronic dacryocystitis were treated with 30 iohexol injection for lacrimal sac lithography. Contrast agents were taken from the lacrimal canal reflux to stop the injection. The CT scan for the lacrimal passage was performed immediately, ②Three-dimensional reconstruction of lacrimal duct and its surrounding structures was performed with Sinuses Trachea I software. ③The lacrimal sac and nasolacrimal canal were cut and depressed using this software simulation. Result：①The incidence of lacrimal duct obstruction were 4.5% （1/22, in lacrimal duct）, 22.7%（5/22, in lacrimal sac）, 13.6%（3/22, transition section）, 36.4% （8/22, in nasocrimal duct） ,and 22.7%（5/22, in Hasner valve） separately. The transitional section, nasolaerimal duct, Hasner valve section 72.7%（16/22） totally. ②The lateral wall of the nasolaerimal duct in 3D visual model is constructed of maxillary lacrimal process. The interior wall of the nasolacrimal duct is made of drop process of lacrimal bone and ascending lacimal process of the inferior turbinate. ③Observed from the inferior meatus, hard nasolacrimal duct is surrounded by inferior turbinate bone, and forms the inside wall of openings of the lacrimal duct. ④The removal of the front parts of the inferior turbinate attached to the lateral nasal can lead to the deperession of the membranous nasolacrimal duct sufficiently, and create the efficient space to eliminate nasolacrimal duct obstruction. Conclusion： Endoscopic nasolacrimal duct decompression surgery is efficacy for the treatment of chronic dacryocystitis. The integrity of the membranous lacrimal duct was reserved, and the complication such as lacrimal sac granulation hyperplasia, lacrimal duct obstruction again caused by scar formation was avoided.