＂＂形鼻黏膜瓣在外伤性泪囊炎手术中的应用

The application of ＂＂ type nasal mucosa flaps during the surgical treatment of traumatic dacryocystitis

目的应用改良外伤性泪囊炎手术的鼻黏膜瓣，观察其疗效。方法26例（27只眼）外伤性泪囊炎患者，均实施了外路泪囊鼻腔吻合术（DCR），术中＂＂形鼻黏膜的前、后瓣分别与泪囊黏膜的前、后瓣对应缝合。观察泪囊和鼻黏膜瓣的对合情况、冲洗是否通畅、流泪症状是否消失。术后随访6月。有内眦韧带断裂者，一期行内眦韧带修复。有明显眼球内陷的眼眶骨折患者，行二期眼眶骨折整复术，与第一次手术间隔3~4月。结果26例（27只眼）外伤性泪囊炎患者中，男20例，女6例，年龄5~63岁。术中发现泪囊和鼻黏膜间距均有不同程度增宽。26例均有不同程度鼻骨或泪骨骨折，其中18例伴内眦韧带断裂、14例伴眼眶骨折。14例伴眼眶骨折的患者中，7例有明显的眼球内陷。术后2周门诊随访，27只眼泪道冲洗均通畅。随访6月，1例儿童患者泪道冲洗为下冲上返，无分泌物；26只眼泪道冲洗均通畅，其中1只眼仍有溢泪症状。结论＂＂形鼻黏膜瓣的长度较＂H＂形鼻黏膜瓣增加2倍，宽度减少2倍，为治疗术中有泪囊和鼻黏膜间距增宽的外伤性泪囊炎提供了一种新手段。

ObjectiveTo modify the nasal mucosa flap during dacryocystorhinostomy for the treatment of traumatic dacryocystitis and observe its therapeutic effect.MethodsTwenty six patients （27 eyes） of traumatic dacryocystitis were performed dacryocystorhinostomy. During the operation, the anterior and posterior nasal mucosa flaps of ＂＂ type was sutured to that of lacrimal sac mucosa flaps of ＂H＂ type. During 6 months, the state of mucosa flaps, tear washing, and tearing symptom was followed up. Patients with median canthoal tendon interruption received tendon repairing simultaneously. Patients with obvious orbital fracture received orbital reconstruction 3 to 4 months later.ResultsAmong 26 patients with traumatic dacryocystitis, 20 male, 6 female, aged 5 to 63. During the operation of all patients, the distance between the nasal mucosa and the lacrimal sac became widen. All had nasal bone, lacrimal bone fracture at different degree; 18 patients with median canthoal tendon interruption, and 14 patients with obvious orbital fracture. Tear washing was smooth in all cases at 2 weeks follow up. At 6 months follow up, tear washing was smooth in 26 cases （one child still had tearing symptom）, obstruction in 1 case.ConclusionsThe nasal mucosa flap of ＂＂ type is 1 time longer and narrower than that of ＂H＂ type, and offer a new way for patients with traumatic dacryocystitis, whom the distance between the nasal mucosa and the lacrimal sac became widen.