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目的提高鼻腔泪囊造口术的成功率。方法于泪囊在鼻腔外侧壁的投影,即中鼻甲的前端,鼻丘处,“工”形切开鼻腔黏膜,形成前后二个“门”形黏膜瓣,磨开骨壁,造口约1 cm,泪囊内侧壁也做同样较小的“工”形切开,形成相似的“门”形泪囊壁瓣,将其前后分别与鼻腔黏膜瓣对应缝合,覆盖骨性造口缘,使造口表面光滑,无纤维肉芽和瘢痕组织形成,不易造成阻塞。硬膜外麻醉导管自泪点进入泪道系统,并自下鼻道鼻泪管开口及造口处拉出,形成两条通道。结果术后7 d拆除固定于造口处的导管上的高分子膨胀材料,“门”形瓣缝合处已愈合,无黏膜的上下部分骨面已有上皮爬行,造口表面黏膜红润、光滑,冲洗泪道通畅,溢泪症状消失。本组慢性泪囊炎的治愈率为97%。结论本改良鼻内镜下鼻腔泪囊造口术的造口光滑,不易形成肉芽。而硬膜外麻醉导管所形成的第二条通道,更加保证了手术的成功。
Objective To improve the success rate of nasal dacryocystorhinostomy. Methods The nasal mucosa was cut in the projection of the dacryocyst on the lateral wall of the nasal cavity, that is, at the front end of the middle turbinate and at the nostril. Two nasal mucosa were formed, Stoma about 1 cm, the dacryocystal inner wall also do the same smaller “workers ” shape cut open to form a similar “door ” shaped lacrimal flap, before and after its corresponding nasal mucosal flap corresponding suture, Overlying the bony stoma, making stoma surface smooth, non-fibrous granulation and scar tissue formation, not easy to cause obstruction. Epidural anesthesia catheter into the lacrimal system from the punctum, and nasolacrimal duct from the lower nasal opening and stoma at the pull out, the formation of two channels. Results On the 7th day after operation, the polymer-expanded material on the catheter fixed at the stoma was healed. The upper and lower parts of the non-mucosal epithelium had been epithelial-crawled, the mucosa on the stoma was rosy, Smooth, flush lacrimal patency, symptoms of overflow tears disappear. The group of chronic dacryocystitis cure rate was 97%. Conclusion This modified endoscopic nasal lacrimal sac stoma is smooth and difficult to form granulation. The second channel formed by epidural anesthesia catheter, more to ensure the success of surgery.