【摘要】 探讨慢性泪囊炎手术治疗的有效方法。方法：收集30例慢性泪囊炎患者，行改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C应用慢性泪囊炎疗效观察。结果：术后随访6～24mo，治愈29例，治愈率97%，无效1例。结论：改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C应用治疗慢性泪囊炎具有治愈率高，面部无瘢痕，出血少，进路直接，泪囊定位准确，同时丝裂霉素棉片留置，有抑制创面肉芽组织生长和纤维瘢痕形成，提高手术成功率。
【关键词】 慢性泪囊炎;鼻内窥镜;泪囊鼻腔吻合;硅胶管;丝裂霉素C
Treatment of chronic dacryocystitis with improved nasal endoscopic dacryocystorhinostomy combined with nasolacrimal intubation and mitomycin C
ZeYun Chen, Yi Zhang, JianJun Guo, ZeHuan Tang，YeZi Liu
1Department of Ophthalmology, Peoples Hospital of Changping Town, Dongguan 523560, Guangdong Province, China; 2Department of Ophthalmology, Nanfang Hospital, Guangzhou 510515, Guangdong Province, China
AbstractAIM: To discuss an effective surgery method for chronic dacryocystitis.METHODS: Thirty patients with chronic dacryocystitis were collected and performed the improved nasal endoscopic dacryocystorhinostomy combined with nasolacrimal intubation and mitomycin C, the effect was observed.RESULTS: The postoperative followup ranged from 6 months to 24 months, 29 patients were cured, the cure rate was 97%, 1 case failed.CONCLUSION: Improved nasal endoscopic dacryocystorhinostomy combined with nasolacrimal intubation and mitomycin C has higher cure rate, little hemorrhage and no scar of face, accurate location, at the same time, the mitomycin cotton was remained, which can prevent the growth of granulation tissue and the formation of fibrous scar, so it can increase the success rate of operation.
KEYWORDS: chronic dacryocystitis;nasal endoscope; dacryocystorhinostomy; silicone tube; mitomycin C
0引言
慢性泪囊炎是临床常见的眼科疾病，传统手术方法为鼻外进路行泪囊鼻腔吻合术，至今广泛临床应用，但术后面部留有切口瘢痕。随着鼻眼相关外科学的发展，鼻内窥镜下经鼻行改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C应用治疗慢性泪囊炎，具有出血少，进路直接，定位准确，面部无瘢痕，造孔处不易有肉芽增生等优点。本组收集2005/2008年30例慢性泪囊炎病例，取得满意效果，报告如下。
1对象和方法
1.1对象
本组30例患者，男19例，女11例。年龄20～60(平均40)岁。病史1.5～5(平均3.2)a，患者均有不同程度溢泪，眼分泌物多，部分病例有内眦红肿，泪道冲洗均以上泪点返流。其中伴有中鼻甲肥大3例，下鼻甲肥大2例，鼻中隔轻度偏曲2例。泪囊碘油造影：未见小泪囊。
1.2方法
手术器械：日本OLYMPUS0,30度鼻内窥镜，内窥镜手术器械，骨凿，泪点扩张器，特制泪道软探针[1]，选用硬膜外麻醉导管(帯盲端部分)距盲端15cm处剪断，用3寸针灸针插入管腔增加管腔硬度，即为软泪道探针。术前准备：常规身体检查，鼻腔内窥镜检查，对严重鼻甲肥大者先行手术治疗。患者取仰卧位，鼻腔分别用10g/L卡因棉片，1g/L肾上腺素棉片表面麻醉3次，20g/L利多卡因，0.1g/L肾上腺素鼻近中鼻甲前端黏膜下浸润麻醉，患眼用爱尔卡因眼药水表面麻醉3次，上下泪小管及泪囊有20g/L利多卡因局部浸润麻醉。以钩突为后界，以中鼻甲附着处为上界，下鼻甲附着为下界，镰状刀片做15mm×10mm大小“[”形骨膜瓣，暴露上颌骨额突及泪骨前部，显露二者连接骨缝，凿去上颌骨额突，分离泪骨前部，并钳除，形成12mm×10mm大小骨窗钩突为后界，以中鼻甲附着处为上界，显露淡蓝色泪囊内壁，经泪小点导入探针，以确定泪囊是否充分暴露，用探针顶起泪囊，用镰状刀倒C形切开泪囊，向后翻转泪囊瓣，覆盖骨孔后缘，清除骨孔周围骨屑及黏膜组织，将0.2g/L丝裂霉素C棉片置于骨孔处5min后生理盐水冲洗泪囊。用2根制作好的软探针[1]分别从上下泪小点插入泪囊，经泪囊造孔到鼻腔，拔出针灸针芯，分别将直径1.2mm硅胶管缝合于上下泪小管导管的非盲端，引导硅胶管下行到鼻腔，从鼻前孔穿出，用 50丝线缝合硅胶管两端，游离于鼻腔。术后复查：1mo内每周冲洗1次。以后每月冲洗1次。鼻内窥镜下清洗鼻腔内血痂及分泌物，水肿黏膜及肉芽。术后3mo拔管。随诊时间6～24mo。
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