外伤性鼻泪管阻塞伴泪囊移位的手术探讨

Surgical treatment of traumatic nasolacrimal duct obstruction with lacrimal sac displacement

目的探讨鼻内镜下鼻腔泪囊吻合术治疗外伤性鼻泪管阻塞伴泪囊移位的安全性及有效性。方法回顾分析11例(11只眼)在鼻内镜下鼻腔泪囊吻合联合泪道置管术治疗单侧外伤性鼻泪管阻塞伴泪囊移位患者临床资料、手术方法及治疗预后。患者术前泪囊造影CT检查,评判局部骨折情况、泪囊位置、大小以及鼻腔结构情况,术中见鼻黏膜完整,以中鼻甲附着处前缘为标致切口鼻黏膜,磨钻磨除错位骨质,造骨窗行鼻腔泪囊吻合。术后随访6个月评估疗效。结果10例患者鼻内镜下鼻腔泪囊吻合顺利,1例因磨除错位骨质松动而联合鼻外径路手术,单纯行鼻内镜下鼻腔泪囊吻合手术成功率为90.91%,无眶内出血等并发症发生;4个月拔出泪道硅胶管,随访6个月,患眼无流泪,泪道冲洗通畅,外伤性鼻泪管阻塞治愈率为100%。结论鼻内镜下手术治疗外伤性鼻泪管阻塞伴泪囊移位安全有效,术前影像评估,术中泪囊定位准确,磨钻用力均衡,防止碎骨片误入眶内,引起眶内血肿或眶蜂窝织炎等并发症。

Objective To investigate the safety and efficacy of nasal endoscopic dacryocystorhinostomy in the treatment of traumatic nasolacrimal duct obstruction with lacrimal sac displacement.Methods This is a retrospective analysis.Clinical,surgical treatment and prognosis data from 11 patients who underwent nasal endoscopic lacrimal sac anastomosis combined with lacrimal duct catheterization in the treatment of unilateral traumatic nasolacrimal duct obstruction with lacrimal sac displacement were obtained.Preoperative dacryocystor CT examination was performed to evaluate the local fracture,the location and size of the lacrimal sac,and the structure of the nasal cavity.During the operation,the nasal mucosa was complete,and the frontal edge of the middle turbinate attachment was used as the incision marker,and the dislocation bone was removed by grinding.Subsequently,a bone window was made to perform nasal lacrimal sac anastomosis.The efficacy was evaluated after 6 months of follow-up.Results The dacryocystorhinostomy under nasal endoscope was successfully done in 10 patients,and the success rate of dacryocystorhinostomy under nasal endoscope was 90.91%,except 1 case who received combined nasal external approach due to the loosening of removed dislocation bone.No intra-orbital hemorrhage or other complications occurred.The silicone tube of the lacrimal duct was removed at 4 months after the surgery,and the patient was followed up for 6 months.No tears were observed in the eyes,and the irrigation of the lacrimal duct was unobvious.The cure rate of traumatic nasolacrimal duct obstruction was 100%.Conclusions Endoscopic surgery for traumatic nasolacrimal duct obstruction with dacryocyst displacement is safe and effective.Preoperative imaging evaluation and accurately intraoperative positioning of the dacryocyst,as well as balanced force with a grinding drill should be applied to prevent broken bone pieces from entering the orbit,causing orbital cellulitis and other complications.