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目的 探讨泪道旁路手术的手术适应证及手术方式的选择.方法 对131例(152只眼)泪道旁路手术进行综合分析.患者采用了唇黏膜桥泪道旁路结膜泪囊鼻腔吻合术和玻璃义管泪道旁路结膜泪囊鼻腔吻合术两种手术方式,对术前检查结果、手术后效果、术后并发症及患者满意程度进行统计分析.结果 唇黏膜桥泪道旁路手术15例(19只眼),玻璃义管泪道旁路手术116例(133只眼).两组泪道阻塞溢泪症状明显,109例(130眼)为泪小管阻塞,泪小管残留部＜ 10 mm.另有22例(22眼)为外伤导致内眦部畸形、眶内壁骨折伴发的泪道阻塞.术后唇黏膜桥泪道旁路手术组出现2例(2只眼,占13.33％)复发,玻璃义管泪道旁路手术组出现18例(19只眼,占16.38％)复发,术后并发症主要表现为吻合口瘢痕增生、肉芽组织增生,术后干眼,眼部不适感等.结论 泪道旁路手术是解决泪道阻塞疾病的有效手段,唇黏膜桥泪道旁路手术和玻璃义管泪道旁路手术都是可选择的有效的治疗方式,相比较后者更易于临床开展;对于外伤导致的内眦部畸形、眶内壁骨折伴发的泪道阻塞,可以选择玻璃义管泪道旁路手术;泪小管阻塞合并泪囊炎患者行泪囊摘除令并以上两种泪道旁路手术可以获得良好效果.,Objective To investigate the indication and operating method for bypass lacrimal surgery.Methods One hundred and fifty-two eyes of 131 patients who had undergone different bypass lacrimal surgeries were analyzed.The patients were randomly divided into two groups.One was conjunctivodacryocystorhinostomy (CDCR) with buccal mucosa group,and the other was CDCR with Pyrex tube placement group.All the patients’ physical examinations,postoperative effect and complications and patients’ satisfaction were reviewed.Results nineteen eyes of 15 cases underwent CDCR with buccal mucosa,and 133 eyes of 116 cases underwent CDCR with Pyrex tube placement.The canalicula were obstructed in 130 eyes of 109 cases and epiphora occurred in 22 eyes of 22 cases because of traumatic inner canthus deformity and medial orbit fracture.2 eyes of 2 cases relapsed after surgery in CDCR with buccal mucosa group which accounted for 13.33％ and 19 eyes of 18 cases relapsed in CDCR with Pyrex tube placement group which accounted for 16.38％.The common complications were granulation at the anastomotic stoma,dry eye,and eye discomfort after surgery.Conclusion Bypass lacrimal surgery including CDCR with buccal mucosa and CDCR with Pyrex tube placement might be effective for canalicular obstruction,and the latter was more easily carried out clinically.For lacrimal duct obstruction because of traumatic inner canthus deformity and medial orbit fracture,CDCR with Pyrex tube placement is more effective.For canalicular obstruction combined with dacryocystitis,dacryocystectomy and CDCR with buccal mucosa or Pyrex tube placement could bring good effect.