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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 feasibility of nasal endoscopic nasolacrimal duct decompression in the treatment of chronic dacryocystitis. Methods: One pair of 22 patients with chronic dacryocystitis were given iohexol injection for dacryocystography. The contrast agent was stopped by reverse flow of the canaliculus, and lacrimal CT scan was performed immediately. (2) Sinuses TracheaⅠ software was used to reconstruct the tear Road and its surrounding structure of three-dimensional visual map; 3 application of the software on the lacrimal sac, nasolacrimal duct simulation “cutting ” decompression. The incidence of lacrimal duct obstruction was 4.5% (1/22) for lacrimal duct, 22.7% (5/22) for lacrimal sac, 13.6% (3/22) for operative segment, and 36.4% (8 / 22.7% (5/22) in the Hasner segment, of which 72.7% (16/22) in the transition segment, nasolacrimal segment and Hasner segment.2 The 3D visual structure showed that the lateral wall of the nasolacrimal duct was composed of maxillary Tear ditch constitutes, the inner wall by the sudden drop of the lacriryctomy and the inferior turbinate upward diarrhea; 3 from the nasal passages, nasolacrimal duct surrounded by the inferior turbinate to form a hard nasolacrimal duct and the inner wall of the opening; 4 Scrape off the front of the inferior turbinate at the attachment of the nasal cavity lateral wall that nasolacrimal duct inside the wall, so that the nasolacrimal duct membrane to be fully open, to relieve the nasolacrimal duct obstruction to create an expansion of space. Conclusion: Endoscopic nasolacrimal duct decompression in the treatment of chronic dacryocystitis is feasible, and retained the integrity of the membranous lacrimal duct to avoid the complications of lacrimal sac caused by incision lacrimal sac granulation hyperplasia, scar formation caused by reocclusion of lacrimal duct .