甲基纤维素在泪囊鼻腔吻合术中应用.docVIP

甲基纤维素在泪囊鼻腔吻合术中应用 　 作者：张冬松，李瑞珍，王 彬，王少鹏，李凯军 【关键词】 甲基纤维素；泪囊；鼻腔；吻合术 　　［摘要］ 目的 通过对慢性泪囊炎患者施行泪囊鼻腔吻合术，手术中在制作泪囊鼻黏膜瓣前应用甲基纤维素，评价其在提高泪囊鼻腔吻合术成功率的作用。方法 33例（35眼）慢性泪囊炎患者男6例，女27例，年龄27～56岁。由同一经验丰富的医生施行泪囊鼻腔吻合术，手术中在制作泪囊鼻黏膜瓣前自泪小管向泪囊内注入甲基纤维素，使泪囊膨起，内外侧壁分离，在泪囊、鼻黏膜上做“工”字形黏膜瓣，并对端吻合。结果 在术后5天、10天用无菌生理盐水充分冲洗泪道，泪道通畅，随访6个月～1年，手术均获得成功。无术中、术后并发症发生。结论 甲基纤维素黏度高、弹性好，在泪囊鼻腔吻合术中制作泪囊黏膜瓣前，将甲基纤维素注入泪囊内，泪囊充盈，使泪囊黏膜瓣的制作更准确、完善，提高了手术成功率。 　　［关键词］ 甲基纤维素；泪囊；鼻腔；吻合术 　　Application of methylcellulose to the dacryocystorhinostomy of lacrimal sac and nasal cavity 　　［Abstract］ Objective To operate the dacryocystorhinostomy for the chronic dacryocystitis,during the operation putting methylcellulose into the lacrimal sac that has been cut before.Evalute the function of improving the successful rate on the dacryocystorhinostomy.Methods There are 33 cases(35 eyes)with chronic dacryocystitis,including male six and female 27,age 27～56.The dacryocystorhinostomy was operated by the same experienced doctor.During the operation putting methylcellulose into the lacrimal sac before cut.When the lacrimal sac was swollen to Make valve like“工”type on it.Results Using physiological saline to flush the lacrimal passage fully after the operation for five and ten days to make it smooth.All of the patients were reexamined after six months to one year.All of the operations were successful without any complications.Conclusion The methylcellulose has high sticky and good elasticity.During the operation put methylcellulose into the lacrimal sac before cut.The lacrimal sac was swollen.Making a valve on the lacrimal sac will be more accurate,perfect and raise the successful rate on the dacryocystorhinostomy. 　　［Key words］ methylcellulose;lacrimal sac;nasal cavity;dacryocystorhinostomy 　　慢性泪囊炎是眼科常见病之一，主要是由于鼻泪管阻塞所致，泪囊鼻腔吻合术是治疗此病的有效手段［1］。多年来眼科医生一直在不断地改进其手术方式，以简化手术操作，提高手术成功率。其中手术的关键在于泪囊鼻黏膜瓣的制作及吻合，形成新的黏膜通道，而达到治愈的目的，这样泪囊黏膜瓣的制作亦较为重要。回顾国内外文献主要在骨孔的制作黏膜吻合方式及防止术后通道阻塞方面有较多报道，而在如何提高泪囊解剖的清晰度，准确、完善地制作泪囊黏膜瓣方面报道较少。术中应用甲基纤维素，使泪囊的解剖更清晰，有利于泪囊黏膜瓣的制作，在此方面的优越性尚未见报道。