泪囊鼻腔吻合术治疗泪囊瘘管

泪囊疫管在临床上并不少见，过去常采用瘘管切除或泪囊摘除手术治疗，残留溢泪的后遗症。我科自1982年以来采用鼻腔泪囊吻合术治疗17例（21眼）泪囊层管，取得了很好的效果，报告如下：1对象和方法1．1一般资料本组17例（21眼），其中男6例7眼，女11例14眼，年龄最小者9岁，最大者37岁，平均18．9岁。先天性疾管8例11眼，急性泪囊炎脓肿切开或自行溃破引起者5例6眼，外伤性瘘管4例4限。曾经有8眼作单纯疾管切除术后复发。1．2手术方法术前用冲洗法和泪道探讨了解泪道有无狭窄和阻塞以及疾管的情况。麻醉同鼻腔泪囊吻合术。切开皮肤，显露泪…     

鼻内镜治疗慢性泪囊炎的疗效分析

目的对慢性泪囊炎经鼻内窥镜行鼻腔泪囊吻合术的疗效观察,以指导临床应用。方法回顾2009年5月—2012年3月该院收治的慢性泪囊炎患者30例31眼,所有患者均行经鼻内窥镜鼻腔泪囊吻合术,术后观察泪道通畅情况。结果 30例31眼术后3~6个月冲洗通畅28眼,通畅欠佳2眼,仍堵塞1眼。结论经鼻内镜鼻腔泪囊吻合术疗效确切,且为微创,较传统手术有较明显优越性。     

鼻内窥镜下泪囊鼻腔造口术治疗慢性泪囊炎的临床观察

目的：观察在鼻内窥镜下泪囊鼻腔造口术治疗慢性泪囊炎的临床疗效。方法对1025眼慢性泪囊炎和鼻泪管阻塞患者在鼻内窥镜下行泪囊鼻腔造口术。结果1023例（1025眼）经随访1～6个月,1001眼治愈,20眼好转,4眼无效。结论鼻内窥镜下行泪囊鼻腔造口术是治疗慢性泪囊炎和鼻泪管阻塞的有效方法。     

高频电刀切割鼻泪管重建术的护理

各种泪道阻塞目前治疗方法主要有泪道疏通法 ,泪道改道法及泪道重建法。我科 1999～ 2 0 0 0年采用高频电刀切割鼻泪管重建术治疗鼻泪管阻塞或慢性泪囊炎 3 2例 (4 6眼 ) ,术后随访 6～ 12月 ,疗效满意 ,现就护理体会报告如下 :1　材料与方法1.1　临床资料　本组慢性泪囊炎 3 4眼 ,单纯鼻泪管阻塞 12眼 ,其中男 10眼 ,女 3 6眼 ;年龄 15～ 70岁 ,平均 3 2 .5岁。所有病人均用泪道冲洗法及泪道探通检查确诊。1.2　材料准备　康威ＣＶ -2 0 0 0型高频电刀。美国产套管针3枚 ,管径为 0 .9ｍｍ ,1.1ｍｍ或 1.3ｍｍ ,磨平针芯尖部 ,使针芯与外套…     

鼻内窥镜下泪囊鼻腔造孔术治疗慢性泪囊炎的临床观察

目的:探讨鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎的临床疗效。方法:所有患者术前均行鼻腔检查、冲洗泪囊,结膜囊内滴入抗生素眼液及泪囊碘油造影术。观察组患者行鼻内窥镜下泪囊鼻腔造孔术,对照组患者行颜面部切口泪囊鼻腔吻合术。术后两组患者均全身使用抗生素3～5 d。鼻腔内滴麻黄碱呋喃西林滴鼻液,5～8次/d,共滴4周。结膜囊内滴抗生素、地塞米松眼液,2～3次/d,共滴2～4周,每天冲洗泪道,随访5个月～3年。结果:所有患者均顺利完成手术,观察组患者治愈38眼占88.37%,有效3眼占6.98%,总有效率95.35,与对照组比较差异有统计学意义(P<0.05)。观察组手术失败2例2眼,1例为鼻内造孔瘢痕孪缩再封闭,1例为外伤所致鼻腔结构异常。对照组手术失败6例6眼,吻合口阻塞4例4眼,1例1眼为骨孔过小,1例为泪囊未切开。结论:鼻内窥镜下泪囊鼻腔造孔术治疗慢性泪囊炎操作简单、出血少、疗效好、并发症少,值得临床推广。     

下泪小管断裂一期显微吻合方法的探讨

眼部外伤泪小管断裂多见 ,若不及时修复则常年溢泪 ,给工作和生活带来诸多不便。手术吻合断裂的泪小管是唯一的治疗方法。在泪小管吻合术中 ,寻找泪囊侧断端是手术成功的关键。于近 2年对 2 8例 2 8眼下泪小管断裂 ,根据断端不同长度 ,采用直视法和环行探针寻找深部断端 ,行一期显微吻合术 ,效果较好 ,报告如下。1 资料与方法临床资料　本组共 2 8例 2 8眼 ,均为单侧下睑及面部外伤伴下泪小管断裂 ,男 2 5例 ,女 3例。年龄 1 3～ 68岁 ,平均 4 2岁。右眼 1 6眼 ,左眼 1 2眼。钝器裂伤 2 1眼 ,锐器切割穿刺 7眼。就诊时间 0 .5～ 36小时。断…     

泪囊鼻腔吻合术治疗慢性泪囊炎65例

为观察慢性泪囊炎的手术效果,采用泪囊鼻家吻合术治疗慢性泪囊炎65例（70眼）,经随访1－8年观察,远期显效率达94．3％,认为该法是治疗慢性泪囊炎的较好方法。     

新生儿泪囊炎120例临床分析

新生儿泪囊炎是小儿常见的眼病之一,它的发生率占新生儿的1.75%～6%。95%以上的病例可通过按摩、冲洗或探通泪道而愈,极少数病例经反复探通泪道等治疗无效[1,2]。我科自1989年以来采用挤压泪囊法、加压冲洗法、泪道探通冲洗法综合治疗新生儿泪囊炎120例136眼,效果满意,报告如下。1　临床资料1)　一般资料:120例136眼新生儿泪囊炎患儿均为门诊病人,其中男69例,女51例。年龄7ｄ～10个月,其中<1个月者5例(5眼),1～6个月78例(92眼),7～10个月37例(39眼)。双眼16例,单眼104例;右眼54例,左眼82例。眼部检查患儿溢泪、内眦部结膜充血、结膜囊有黏液…     

单瓣泪囊鼻腔吻合术

目的探讨单瓣泪囊鼻腔吻合术治疗慢性泪囊炎的手术效果。方法在局麻下行单瓣泪囊鼻腔吻合术72例76眼，术后行泪道冲洗，并观察溢泪流泪情况。结果72例患者平均随访3．6个月，治愈72眼（94．7％），好转3眼（4．0％），无效1眼（1．3％），总有效率达98．7％。无效眼术后1个月复查反复冲洗泪道不通，鼻科检查见吻合口肉芽组织增生堵塞。结论单瓣泪囊鼻腔吻合术较传统的手术有简便易行、并发症少的优点，较鼻内窥镜下的吻合术有物美价廉的优点。     

高频电灼术联合硅胶管植入治疗泪道阻塞63例

目的：观察高频电灼术联合硅胶管植入治疗泪道阻塞的效果。方法：选择2008年7月～2011年6月我院收治的泪道阻塞患者63例114眼,其中,单纯泪道阻塞45例83眼,合并慢性泪囊炎18例31眼,均采用高频电灼联合硅胶管植入进行治疗,术后用抗生素加激素冲洗,随访观察6～12个月。结果：单纯泪道阻塞治愈39例68眼,好转10例13眼,无效2例2眼,有效率为97．6％;合并慢性泪囊炎治愈15例24眼,好转5例6眼,无效1例1眼,有效率为96．8％。结论：高频电烧灼术联合硅胶管植入治疗泪道阻塞取得了满意的治疗效果。     

鼻内镜下鼻腔泪囊造口联合泪道全程置管术治疗慢性泪囊炎合并鼻泪管阻塞的疗效观察

目的：探讨鼻腔泪囊造口联合泪道全程置管术治疗慢性泪囊炎合并鼻泪管阻塞的疗效。方法对53例（63眼）在鼻内镜下行鼻腔泪囊造口联合泪道全程置管术治疗慢性泪囊炎合并鼻泪管阻塞的患者进行回顾性分析,随访6-12个月。结果在53例（63眼）患者中,治愈52眼（82.54％）,好转8眼（12.70％）,无效3眼（4.76％）,治疗总有效率为95.24％。术后并发症少。结论该方法治疗慢性泪囊炎合并鼻泪管阻塞的创伤小,操作简便,有效率高,疗效安全可靠。     

Nd∶YAG激光对诱导家兔视网膜-脉络膜静脉吻合术成功率的影响

目的：探讨利用Nd∶YAG激光提高视网膜-脉络膜静脉吻合术的成功率。方法：灰色家兔20只（40只眼）用氩激光建立视网膜分支静脉阻塞(BRVO)模型，模型成功家兔随机分为实验组10只（20只眼），用氩激光随后用Nd∶YAG激光；对照组10只（20只眼），单独用氩激光诱发形成视网膜和脉络膜静脉间的吻合。结果：通过眼底荧光血管造影(FFA)检查和彩色眼底照像，实验组6只眼成功建立视网膜脉络膜吻合，检眼镜下激 光击射部位静脉中断呈漏斗状陷入脉络膜；FFA显示远端及近端静脉内血流汇入吻合处，吻合形成时间为4~6周，对照组未形成吻合。观察2~6个月由激光击射引起的视网膜或玻璃体出血均在8周内吸收，未见其他严重并发症。结论：用Nd∶YAG激光可提高诱导视网膜脉络膜静脉吻合的成功率。     

鼻泪管支架植入术治疗鼻泪管阻塞的护理

目的：探讨鼻泪管支架植入术治疗鼻泪管阻塞的护理。方法：对106例（110眼）经逆行扩张鼻泪道后植入鼻泪管支架治疗鼻泪管阻塞的患者进行积极的护理,观察其疗效。结果：110眼中,成功植入鼻泪管支架106眼,手术成功率96.4%,成功的106眼术后随访3个月,有效率为92.5%;随访1＋年,有效率为80.2%。结论：鼻泪管支架植入术是一种简单、安全有效治疗鼻泪管阻塞的方法,而手术前后合理的护理措施对保证手术疗效十分重要。     

鼻内镜下鼻腔泪囊吻合术37例临床分析

目的探讨鼻内镜下鼻腔泪囊吻合术治疗慢性泪囊炎的疗效和临床特点。方法对2006年1月～2012年6月我院收治的37例（42眼）慢性泪囊炎患者行鼻内镜下鼻腔泪囊吻合术,并回顾分析其临床资料、总结手术方法、观察临床疗效。结果37例（42眼）患者术后均随访6个月以上,治愈32例（37眼）,好转4例（4眼）,无效1例（1眼）。结论鼻内镜下鼻腔泪囊吻合术是治疗慢性泪囊炎的一种有效方法,且通过对鼻一鼻窦疾病的治疗及术后随访处理可提高鼻内镜下鼻腔泪囊吻合术的疗效。     

改良泪囊挤压按摩法治疗先天性鼻泪管阻塞的疗效

目的探讨改良泪囊挤压按摩法治疗先天性鼻泪管阻塞的疗效。方法对1991年6月~2005年6月收治的34例(36眼)先天性鼻泪管阻塞患者行泪囊挤压按摩,并行泪囊区和迎香穴按摩,按摩后并滴抗菌药物眼药水、眼药膏。结果34例(36眼)患者中33例35眼获得治愈,无效1例改行骨性泪道探通术治愈。结论改良泪囊挤压按摩法治疗先天性鼻泪管阻塞,方法简单易行,无副作用。     

激光联合3种治疗方法治疗泪道阻塞临床效果分析

目的 探讨YAG激光联合3种治疗方法治疗泪道阻塞的临床疗效.方法 ①YAG激光联合泪道逆行插管35例(36眼);②YAG激光联合典必殊眼膏治疗20例(22眼);③YAG激光联合新型泪道引流管10例(10眼).以上3种方法治疗泪道阻塞65例(68眼),均随访6～12个月,病状、体征消失为治愈的标准.结果 YAG激光联合泪...     

鼻泪管内义管植入治疗泪道阻塞及慢性泪囊炎的护理

目的:提高鼻泪管内义管植入术的成功率及患者的满意度。方法:分析总结46例(52只眼)行鼻泪管内义管植入术治疗泪道阻塞及慢性泪囊炎患者的护理经验,结果:术后随访3~6月,治愈率为95%。结论:术前心理护理、术后健康指导、恰当的泪道冲洗、义管的保护是手术成功的保证。     

Comparison between total laparoscopy and laparoscopy-assisted distal gastrectomy for gastric cancer: A meta-analysis based on Japanese and Korean articles

Objectives:

To assess the safety and feasibility of total laparoscopy distal gastrectomy (TLDG).

Methods:

This meta-analysis was conducted between April and July 2013 in Sichuan Cancer Hospital, Chengdu, China. We searched PubMed, EMBASE and China Knowledge Resource Integrated Database updated until May 2013. Eight retrospective studies and one prospective study involving 2,046 total patients were included.

Results:

The results showed that TLDG was associated with lower blood loss (mean difference=-22.39, p=0.04). and a greater number of harvested lymph nodes (mean difference=2.74, p=0.02). There was no significant difference between the 2 groups in operation time, time to first flatus, length of postoperative hospital stay, and postoperative complications.

Conclusion:

Compared with laparoscopy-assisted distal gastrectomy, TLDG resulted in reduced blood loss, and a greater number of harvested lymph nodes. Total laparoscopy distal gastrectomy is safe and feasible for gastric cancer.Laparoscopic surgery has been favored by surgeons. Compared with the conventional open surgery, laparoscopy-assisted distal gastrectomy (LADG) is acknowledged as having many advantages, such as lower blood loss, faster recovery, and shorter hospital stays.1,2 The LADG has not only been widely used in early gastric cancers and gastrointestinal stromal tumors, but has also been used in advanced gastric cancers.3,4 As surgery techniques advanced and the endoscopic linear stapler was developed, total laparoscopy distal gastrectomy (TLDG) was gradually applied.5 For TLDG, tumor location determination, specimen removal, and anastomotic reconstruction are different from LADG. Intracorporeal gastrointestinal anastomosis is the major difference between LADG and TLDG.6 A side-to-side anastomosis using a linear stapler, called “delta-shaped anastomosis,” is widely performed by gastrointestinal surgeons. Although there are difficulties associated with intracorporeal anastomosis, TLDG is considered to be less invasive, and results in smaller wounds, and is accepted by most surgeons.7,8 Many studies have been performed to compare the short-term clinical outcomes of TLDG and LADG, but there were many differences in the data in these studies. Therefore, we performed this meta-analysis to compare the immediate postoperative outcomes of TLDG, and LADG for gastric cancer, and to further assess the safety and feasibility of TLDG.     

先天性脉络膜缺损合并视网膜脱离的玻璃体视网膜手术6例分析

目的　评价玻璃体视网膜手术在治疗先天性脉络膜缺损合并视网膜脱离中的效果。方法　 6例 ( 6只眼 )先天性脉络膜缺损合并视网膜脱离患者均采用经睫状体平坦部的三切口闭合式玻璃体手术 ,其中 3只眼填充硅油 ,3只眼填充C3F8。结果　所有 6只眼视网膜均解剖复位 ,术后 4只眼视力提高 ,2只眼同术前视力 ,平均随访时间 3 .6个月 ( 1月— 12月 )。结论　玻璃体视网膜手术联合硅油或C3F8填充术是目前治疗先天性脉络膜缺损合并视网膜脱离的有效方法     

Persistent primitive trigeminal artery associated with monocular blindness and external carotid-vertebral artery anastomosis

In this paper, we present 2 rare cases of persistent embryonic anastomoses. In one case, the patient presented with persistent trigeminal artery along with multiple foci of cerebral infarction as well as central retinal artery thrombosis. In the other case, the patient had direct anastomosis of the vertebral artery with ipsilateral external carotid artery as well as pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery. The findings in these cases may shed light on the clinical presentation of such persistent anastomoses and aid their detection in clinical settings.The primitive trigeminal artery (PTA) is a temporary embryonic vascular anastomosis between the carotid and vertebrobasilar arteries. The persistence of the PTA into adulthood is an uncommon congenital cerebrovascular variation that results in an abnormal anastomosis between the carotid and basilar arteries. The incidence of persistent PTA (PPTA) was reported to be 0.1-1.0%.1,2 The advances in neuroimaging techniques have led to the increased detection of PPTA and prompted considerable research interest in its clinical significance.3,4 Studies have shown that in approximately 25% of the cases, PPTA occurs in combination with other cerebrovascular lesions, such as aneurysms,5 cavernous fistula, and arteriovenous malformation,6,7 which are clinically manifested as trigeminal neuralgia, paralysis of the oculomotor nerve or abducens nerve, or palsy of the trochlear nerve.2 These conditions can lead to compression of the brain stem and, eventually, cerebral ischemia.8 The detection of the PTA is also important from the standpoint of the safety of surgical and interventional procedures performed on the affected population. However, changes of cranial hemodynamics associated with PPTA are complicated, and how and what PPTA lead to stroke is also unclear. The PPTA linked to central retinal artery occlusion and embolic stroke are a rarely reported cerebral vascular accident. The objective of this study is to present 2 cases of rare types of PPTA diagnosed on the bases of the findings of brain magnetic resonance angiography (MRA). In the first case, the PPTA occurred along with multiple foci of cerebral infarction and central retinal artery thrombosis. In the second case, the patient had direct anastomosis of the vertebral artery with the ipsilateral external carotid artery, in combination with pontine infarction, aneurysm, and unilateral hypoplasia of the vertebral artery.