摘要
目的应用泪道CT造影(CT-DCG)多平面重组(MPR)检查研究外路泪囊鼻腔吻合术后慢性泪囊炎复发患者吻合道的特征,分析慢性泪囊炎复发的原因,为合理制定后续治疗方案提供影像学依据。方法收集2014年10月至2020年7月在解放军总医院眼科医学部泪器病中心就诊的87例(87眼)外路泪囊鼻腔吻合术后慢性泪囊炎复发患者资料。87例患者均行CT-DCG MPR检查,对吻合道的骨孔大小、位置情况、吻合道前瓣塌陷及缝线肉芽肿形成情况、鼻腔狭窄粘连、中鼻甲遮挡及鼻黏膜萎缩糜烂情况、吻合道误入鼻窦及吻合道内瘢痕异常增生等情况进行分析。根据CT-DCG MPR检查的特征推测吻合道阻塞泪囊炎复发的原因,并在二次手术中观察验证。结果CT-DCG MPR检查结果显示,骨孔异常25眼骨孔过小16眼(18.39%),骨孔位置偏高8眼(9.20%),骨孔位置偏低1眼(1.15%)。吻合道膜性组织异常21眼前瓣塌陷12眼(13.79%),缝线肉芽肿至黏膜闭锁9眼(10.34%)。鼻腔异常病变22眼术侧鼻腔狭窄粘连6眼(6.90%),鼻中隔偏向术侧6眼(6.90%),中鼻甲遮挡吻合孔7眼(8.05%),鼻黏膜萎缩糜烂3眼(3.45%)。误吻入鼻窦8眼泪囊筛窦吻合7眼(8.05%),泪囊上颌窦吻合1眼(1.15%)。吻合道瘢痕异常增生6眼(6.90%)。另外,混合型5眼(5.75%)。术后验证与术前推测的结果符合率达97.70%。结论CT-DCG MPR检查能够清晰显示外路泪囊鼻腔吻合术后慢性泪囊炎复发患者的泪道及鼻腔的组织结构,可以显示吻合道阻塞的特征,有助于判断慢性泪囊炎复发的原因,并指导合理制定再次治疗的方案。
Objective To investigate the cause of recurrence of chronic dacryocystitis after external dacryocystorhinostomy(DCR)using the multiplanar reconstruction(MPR)computed tomographic-dacryocystography(CT-DCG),in order to improve the surgical skills and make a reasonable reversion treatment plan.Methods Medical data of 87 patients(87 eyes)with recurrence of chronic dacryocystitis after external DCR admitted to the Lacrimal Center of Ophthalmology Division of PLA General Hospital from October 2014 to July 2020 were collected and analyzed.All 87 patients underwent the CT-DCG MPR,and main outcome measures including bony ostium,mucosal ostium,structural abnormalities in the nasal cavity,mismatched intraoperatively and extensive scarring were analized.According to the features of the CT-DCG MPR,the causes of the recurrence were speculated and verified in a reversion surgery.Results The CT-DCG MPR showed 25 eyes had abnormal bony ostium including over small bony ostium in 16 eyes(18.39%),high position of bony ostium in 8 eyes(9.20%),and low position of bony ostium in 1 eye(1.15%);21 eyes had abnormal mucosal ostium including anterior valve collapse in 12 eyes(13.79%),suture granuloma in 9 eyes(10.34%);22 eyes had structural abnormalities in the nasal cavity including operative side nasal stenosis and adhesion in 6 eyes(6.90%),deviation of nasal septum to the operative side in 6 eyes(6.90%),middle turbinate occlusion in 7 eyes(8.05%),and atrophy of nasal mucosa in 3 eyes(3.45%);8 eyes were mismatched intraoperatively including dacryocyst ethmoid anastomosis in 7 eyes(8.05%),and dacryocyst anastomosis of maxillary sinus in 1 eye(1.15%).Six eyes were extensive scarring(6.90%).In addition,5 eyes(5.75%)were mixed.The postoperative compliance rate reached 97.70%.Conclusion CT-DCG MPR examination can clearly show the tissue structure of the lacrimal duct and nasal cavity of patients with recurrence of chronic dacryocystitis after external DCR.It can show the characteristics of anastomotic duct obstruction and help determine the cause of chronic dacryocystitis recurrence,which can guide the reasonable formulation of re-treatment plan.
作者
王立华
白芳
陶海
刘昊
周希彬
王朋
王菲
柳川
WANG Lihua;BAI Fang;TAO Hai;LIU Hao;ZHOU Xibin;WANG Peng;WANG Fei;LIU Chuan(Lacrimal Center of Ophthalmology Division,PLA General Hospital,Beijing 100039,China;Department of Radiology,Third Medical Center of PLA General Hospital,Beijing 100039,China)
出处
《眼科新进展》
CAS
北大核心
2021年第7期651-655,共5页
Recent Advances in Ophthalmology
关键词
泪道CT造影多平面重组
泪囊鼻腔吻合术
复发性慢性泪囊炎
骨孔
multiplanar reconstruction computed tomographic-dacryocystography
dacryocystorhinostomy
recurrent chronic dacryocystitis
bony ostium
