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我们自行设计结膜鼻腔粘膜吻合术,再造泪道,共治疗4例,观察10～16月,均获得成功。一、手术方法:切口与鼻腔泪囊吻合术相同。造骨孔也与鼻腔泪囊吻合术相同。骨孔偏向泪囊窝前下方约15×15mm。在鼻侧球结膜做以泪阜为基底的7×8mm 呈“工”形的结膜瓣,分离泪阜及筋膜间组织。用线状刀斜形贯穿眼轮匝肌和鼻翼肌,宽约10～12mm。纯性分离成扁平腔道与泪囊创腔相通。把结膜瓣向内拆,由泪囊创腔引出,做为隧道前壁。在第一结膜瓣的上方做一个12×8mm 带蒂结膜瓣。转位平辅在隧道后壁,带蒂端固定缝合在巩膜创面,另端引出泪囊创腔。纵“工”形切开鼻粘膜。以结膜瓣的长短做前后瓣的大小,原则上前瓣大,后瓣小。将双后瓣对位缝合,置5mm 直径硅胶管,其下端下达鼻腔,上至结膜囊,内引一细管与之固定缝合,使粗管呈椭圆形,细管分别由睑裂、鼻腔引出固定。泪囊创腔及鼻骨孔填充油纱条并引出鼻外,两前瓣对位缝合4针后,缝合皮肤。48小时后取出纱条,每日活动硅胶管,
We designed conjunctival nasal mucosal anastomosis, reconstruction of lacrimal duct, a total of 4 cases were observed 10 to 16 months, were successful. First, the surgical methods: incision and nasal dacryocystorhinostomy the same. Bone hole and nasal dacryocystorhinostomy the same. Bone hole bias toward the lower part of the lacrimal sac about 15 × 15mm. In the nasal bulb conjunctiva do tear Fu as the base of 7 × 8mm was “Gong” -shaped conjunctival flap, tear tear and fascia between the organization. Oblique with a linear knife through the orbicularis muscle and the wing muscle, width of 10 ~ 12mm. Purely separated into a flat cavity and lacrimal duct cavity interlinked. The conjunctival flap removed inward, derived from the lacrimal sac, as the tunnel anterior wall. A 12 x 8 mm pedicle conjunctival flap was made above the first conjunctival flap. Transposition of flat auxiliary in the tunnel wall, pedicle fixed suture wound in the sclera, the other leads to lacrimal cavity. Longitudinal “workers” shape cut nasal mucosa. The length of the conjunctival flap to do before and after the size of the valve, in principle, the anterior valve large, small flap. The double posterior valve sutured, set 5mm diameter silicone tube, the lower end of the nasal cavity, up to the conjunctival sac, a small tube with a fixed suture, the thick tube was oval, thin tube were blepharophimosis, nasal lead fixed. Dacryocyst wound cavity and nasal bone filling oil gauze and leads to the nose, the two anterior lobe suture needle 4, the suture the skin. Remove the gauze after 48 hours, the daily activities of silicone tube,