泪囊瓣与前组筛窦黏膜瓣吻合的内镜下泪囊鼻腔吻合术治疗前组筛窦过度气化的慢性泪囊炎

doi:10.3760/cma.j.cn115909-20210830-00346

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摘要目的：探讨前组筛窦气化至上颌骨额突时的成年慢性泪囊炎患者采取泪囊瓣与前组筛窦黏膜瓣吻合的内镜下泪囊鼻腔吻合术（En-DCR）的可行性。方法：前瞻性研究。收集2017年7月至2019年3月在温州医科大学附属眼视光医院，通过泪道CT造影（CT-DCG）确诊的前组筛窦气房气化至上颌骨额突的成年慢性泪囊炎并接受En-DCR的患者。手术步骤：切开鼻黏膜的同时开放并扩大前组筛窦，再进行常规En-DCR手术，最后将泪囊瓣与前组筛窦黏膜瓣进行吻合。对随访超过12个月的患者，记录手术的成功率及并发症。结果：纳入前组筛窦气房气化至上颌骨额突并接受En-DCR的成年慢性泪囊炎患者84例（90眼）。En-DCR的成功率为87%（78/90）。术后出现再次泪道阻塞12眼，其中肉芽阻塞造瘘口7眼，瘢痕闭锁造瘘口4眼，泪总管阻塞1眼。术后均未出现眼眶脂肪脱垂、脑脊液漏、鼻窦炎、视力损害等严重并发症。结论：开放前组筛窦完整暴露泪囊窝行En-DCR，通过泪囊瓣与前组筛窦黏膜瓣的吻合方法，对前组筛窦气房气化至上颌骨额突的慢性泪囊炎患者是可行且有效的。

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关键词 ：内镜下鼻腔泪囊吻合术, 前组筛窦开放, 黏膜吻合

Abstract：Objective: To demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with lacrimal sac flap and anterior ethmoid sinus mucosal anastomosing in patients with chronic dacryocystitis with anterior ethmoid air cells entering the frontal process of the maxilla. Methods: A retrospective analysis was performed on adult patients with anterior ethmoid air cells entering the frontal process of the maxilla who underwent En-DCR between July 2017 and March 2019. Patients who were followed up for more than 12 months were included in this study. Anterior ethmoidectomy was the first stage of the operation to open and widen the anterior ethmoid air cells, then routine En-DCR was performed on each patient. In the last step of the surgery, anastomosis was performed on the mucosal dacryocystitis and anterior ethmoid sinus. The success rate of ostial patency and complications were recorded. Results: Ninety eyes of 84 patients with anterior ethmoid air cells entering the frontal process of the maxilla underwent En-DCR. The success rate of En-DCR was 87% (78/90). Twelve eyes had postoperative obstruction which was caused by granuloma in seven eyes, scar synechia in four eyes, and common canalicular stenosis in one eye. There were no serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis or visual impairment. Conclusions: En-DCR was performed by completely exposing the anterior screening sinus, and it was feasible and effective in patients with gasification of the anterior maxillary frontal process in the anterior group.

Key words： endonasal dacryocystorhinostomy anterior ethmoidectomy flap anastomosing

收稿日期: 2021-08-30

PACS:

基金资助:“光健康”国家重点研发计划（2017YFB0403700）；温州市科技局科研项目（Y2020362）

通讯作者: 余波（ORCID：0000-0002-0836-9692），Email：yubo312@126.com

引用本文:

蒋晓卉, 梅嘉慷, 孙兰芳, 等. . 泪囊瓣与前组筛窦黏膜瓣吻合的内镜下泪囊鼻腔吻合术治疗前组筛窦过度气化的慢性泪囊炎[J]. 中华眼视光学与视觉科学杂志, 2022, 24(4): 292-297. Xiaohui Jiang, Jiakang Mei, Lanfang Sun, et al. En-DCR with Lacrimal Sac Flap and Anterior Ethmoid Sinus Mucosal Anastomosing in Patients with Chronic Dacryocystitis with Anterior Ethmoid Air Cells Entering the Frontal Process of the Maxilla. Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(4): 292-297. DOI: 10.3760/cma.j.cn115909-20210830-00346

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210830-00346 或 https://www.cjoovs.com/CN/Y2022/V24/I4/292

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