【摘要】：慢性淚囊炎是由于鼻淚管狹窄或阻塞,淚液潴留于淚囊內(nèi)激發(fā)感染而導(dǎo)致的眼部常見疾病,作為眼部的感染病灶,對眼球構(gòu)成潛在威脅。如果眼球外傷或施行內(nèi)眼手術(shù),容易引起化膿性感染,發(fā)生細(xì)菌性角膜潰瘍或化膿性眼內(nèi)炎,嚴(yán)重者者可導(dǎo)致失明。有人形象的稱之為“眼球旁的定時炸彈”。 慢性淚囊炎主要是由于淚囊以下的淚道阻塞,即鼻淚管阻塞時淚液無法從淚道排出,積聚于淚囊內(nèi),繼發(fā)細(xì)菌感染所致。慢性淚囊炎的診斷并不復(fù)雜,通過詢問病史,行淚道沖洗后即可確診。除慢性淚囊炎急性發(fā)作時需先抗生素控制急性炎癥,轉(zhuǎn)為慢性后再行手術(shù)治療外,一般情況淚道阻塞導(dǎo)致的慢性淚囊炎均可擇期行局部治療,至今治療慢淚囊炎的方法多種多樣,常用的有淚道沖洗法、淚道探通法、淚道植管法、鼻腔淚囊吻合術(shù)、激光淚道疏通術(shù)等,鼻內(nèi)鏡下淚囊鼻腔吻合術(shù)(也有文獻(xiàn)稱之為鼻內(nèi)鏡下淚囊鼻腔造孔術(shù))及淚小點(diǎn)進(jìn)路YAG激光輔助下淚囊鼻腔造孔術(shù)是淚囊鼻腔吻合術(shù)的改良術(shù)式。根據(jù)手術(shù)的原理將治療慢性淚囊炎的術(shù)式分為兩類,一類是淚道改道(淚囊鼻腔吻合術(shù)、鼻內(nèi)鏡下淚囊鼻腔造孔術(shù)、淚小點(diǎn)進(jìn)路YAG激光輔助下淚囊鼻腔造孔術(shù)),另一類是解除原有淚道的阻塞(淚道疏通、鼻淚管植管術(shù)、淚道激光疏通等)。由于鼻淚管纖細(xì)狹長,位置特殊,解除其阻塞較困難,且容易造成內(nèi)壁損傷,瘢痕化而再次阻塞。傳統(tǒng)的鼻腔淚囊吻合術(shù)1904年由Toti首創(chuàng),由于學(xué)者們的改進(jìn)及手術(shù)技巧的提高,鼻腔淚囊吻合術(shù)成功率可以達(dá)90%以上,但存在容易出血,遺留面部瘢痕,副損傷大等缺點(diǎn),該術(shù)式已經(jīng)很少在臨床中使用。1989年,McDonogh首創(chuàng)了應(yīng)用鼻內(nèi)窺鏡經(jīng)鼻腔行淚囊鼻腔造孔術(shù)吻合術(shù)治療慢性淚囊炎,由于經(jīng)鼻腔進(jìn)路,所以面部不會遺留瘢痕,更容易被患者接受。M W Yung等人總結(jié)了鼻內(nèi)鏡下淚囊鼻腔吻合術(shù)應(yīng)用于鼻淚管阻塞導(dǎo)致的慢性淚囊炎的治療,治愈率達(dá)93%。淚小點(diǎn)進(jìn)路YAG激光輔助下淚囊鼻腔造孔術(shù)是在鼻內(nèi)鏡下淚囊鼻腔吻合術(shù)的基礎(chǔ)上發(fā)展起來的一種治療慢性淚囊炎的術(shù)式。本研究通過對兩種術(shù)式的對比,論證淚小點(diǎn)進(jìn)路 YAG激光輔助下淚囊鼻腔造孔術(shù)的臨床使用價值。研究結(jié)果顯示:采用鼻內(nèi)窺鏡檢查、淚道沖洗的形式進(jìn)行術(shù)后隨訪。A組為淚小點(diǎn)進(jìn)路YAG激光輔助下淚囊鼻腔造孔術(shù),B組為鼻內(nèi)鏡下淚囊鼻腔吻合術(shù)。(1)兩種手術(shù)方式的時間比較具有顯著的統(tǒng)計學(xué)差異(P0.01),A組的手術(shù)時間要短于B組。(2)兩種手術(shù)方式出血量的比較,A組顯著少于B組(P0.01)(3)兩種術(shù)式治療費(fèi)用比較具有顯著的統(tǒng)計學(xué)差異(P0.01),A組治療費(fèi)用少于B組。(4)治療效果的比較,兩組無明顯統(tǒng)計學(xué)差異。(5)兩組手術(shù)并發(fā)癥無明顯統(tǒng)計學(xué)差異。 本研究結(jié)果表明,淚小點(diǎn)進(jìn)路YAG激光輔助下淚囊鼻腔造孔術(shù)治療慢性淚囊炎具有用時短,出血少,費(fèi)用低,療效高的優(yōu)點(diǎn),適合推廣。
[Abstract]:Chronic dacryocystitis is a common ocular disease caused by the stricture or obstruction of nasolacrimal duct and the retention of tear in the lacrimal sac to stimulate infection. As an infective focus of the eye, it poses a potential threat to the eyeball. If eyeball trauma or intraocular surgery is easy to cause suppurative infection, bacterial corneal ulcer or suppurative endophthalmitis, severe can lead to blindness. Some people vividly call it the "time bomb next to the eyeball." Chronic dacryocystitis is mainly caused by the obstruction of lacrimal passage below the dacryocyst, that is, when the nasolacrimal duct is blocked, the tear can not be discharged from the lacrimal duct, which accumulates in the dacryocystis and causes secondary bacterial infection. The diagnosis of chronic dacryocystitis is not complicated. In addition to the acute attack of chronic dacryocystitis, the acute inflammation should be controlled by antibiotics first, and then the operation should be performed later. In general, the chronic dacryocystitis caused by obstruction of lacrimal passage can be treated locally. So far, there are a variety of methods to treat chronic dacryocystitis, such as lacrimal passage irrigation, lacrimal passage probing, lacrimal duct implantation, nasolacrimal sac anastomosis, laser lacrimal duct drainage, etc. Endoscopic dacryocystorhinostomy (also known as endoscopic dacryocystorhinostomy) and lacrimal dot approach (YAG laser assisted dacryocystorhinostomy) are the improved methods of dacryocystorhinostomy. According to the principle of operation, the treatment of chronic dacryocystitis was divided into two types: lacrimal duct diversion (dacryocystorhinostomy, endoscopic dacryocystorhinostomy, lacrimal dot approach, YAG laser assisted dacryocystorhinostomy). Another is to remove the obstruction of the original lacrimal passage (lacrimal duct dredging, nasolacrimal tube implantation, lacrimal duct laser dredging, etc.). Because of the narrow and narrow nasolacrimal duct, it is difficult to remove the obstruction of nasolacrimal duct. The traditional nasolacrimal sac anastomosis was initiated by Toti in 1904. The success rate of nasolacrimal sac anastomosis can reach more than 90% due to the improvement of scholars and surgical techniques. In 1989, McDonogh initiated a dacryocystorhinostomy through the nasal cavity for the treatment of chronic dacryocystitis. Because of the transnasal approach, no scar was left on the face. . M W Yung et al summarized the application of endoscopic dacryocystorhinostomy in the treatment of chronic dacryocystitis caused by obstruction of nasolacrimal duct. The cure rate was 933%. YAG laser assisted dacryocystorhinostomy is a new method for the treatment of chronic dacryocystitis based on endoscopic dacryocystorhinostomy. This study demonstrated the clinical value of dacryocystorhinostomy with YAG laser assisted lacrimal punctate approach. The results showed that the patients were followed up by endoscopy and lacrimal passage irrigation. Group A was treated by lacrimal punctate approach YAG laser assisted dacryocystorhinostomy. Group B was treated by dacryocystorhinostomy under nasal endoscope. (1) there was significant difference in the time of operation between the two methods (P0.01), A group was shorter than that in B group; (2) the amount of bleeding in two kinds of operation methods was lower than that in B group. The cost of treatment in group A was significantly less than that in group B (P0.01). (3) there was a significant difference in the cost of treatment between the two groups (P0.01), A group was less than that in group B). (4) the effect of treatment. There was no significant difference between the two groups. (5) there was no significant difference in operative complications between the two groups. The results showed that the treatment of chronic dacryocystitis by YAG laser assisted dacryocystorhinostomy had the advantages of short time, less bleeding, low cost and high curative effect, and was suitable for popularization.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.6

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相關(guān)期刊論文 前10條

1 周兵;黃謙;韓德民;崔順九;劉銘;劉華超;張永杰;;改良經(jīng)鼻內(nèi)鏡下淚囊鼻腔造孔術(shù)[J];中國耳鼻咽喉頭頸外科;2008年02期

2 周兵，唐p，

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