激光指示光引导鼻内镜下手术治疗外伤性鼻泪管阻塞伴泪囊移位

目的 观察通过激光指示光引导定位泪囊，行鼻内镜下泪囊鼻腔吻合手术治疗泪囊移位的方法。方法 对12例（12眼）经CT、MRI或泪囊造影后证实泪骨、鼻骨、或上颌骨鼻突骨折造成鼻泪管阻塞和泪囊移位，在局麻下激光指示光针于上或下泪小管进入泪囊，鼻内镜光源反复打开和关闭以观察指示光最靠近骨窗的最佳位置，切开相应鼻黏膜，做骨窗，然后顺势扩大鼻黏膜和骨窗口，准确找到泪囊后放入泪囊鼻腔引流支架。结果 12眼外伤性鼻泪管阻塞伴泪囊移位采用上述方法均顺利完成泪囊鼻腔吻合手术，术中大大减少了手术探查寻找泪囊带来的鼻黏膜和骨组织过多的损伤，术中患者痛苦少，术后恢复快，鼻腔换药次数减少。结论 激光指示光引导行鼻内镜下泪囊鼻腔吻合手术其定位准确，操作简单，组织损伤少，手术时间短。

Laser-guided endoscopic dacryocystorhinostomy for traumatic nasolacrimal duct obstruction and lacrimal sac displacement

Objective To evaluate the clinical effect of laser-guided endoscopic daeryocystorhinostomy for nasolacrimal duct obstruction with lacrimal sac displacement. Methods Tweleve eyes of 12 cases of nasolacrimal duct obstruction with lacrimal sac displacement were treated by laser-guided endoscopic dacryoeystorhinostomy. The lacrimal sac displacement was caused by fracture of lacrimal bone, nasal bone or maxillary bone process, which was identified by CT, MRI or lacrimal sac radiography. The operation was performed under local anesthesia. The laser indicator was inserted into the sac through puncture. The location closest to the bone window was found by repeatedly turning on and off the laser light. The nasal mucosa was cut off subsequently. The bone window was opened and expanded, and the nasal lacrimal drainage stent was placed after the lacrimal sac was found accurately. Results The surgery was performed successfully in all of the 12 cases, with less damage to nasal mucosa or bone tissue, less pain, faster recovery and fewer times of dressing change compared with traditional method. Conclusion For nasolacrimal duct obstruction with lacrimal sac displacement, laser-guided endoscopic dacryocystorhinostomy is accurate in localization, easy to operate with little tissue damage and short operative time.