目的：通过在血管灌注尸头标本上模拟经鼻内镜下鼻泪管-泪囊切除术探讨该术式的基本操作以及在经鼻内镜下鼻泪管-泪囊和其周围结构的解剖关系，以期为临床开展该术式提供解剖学依据。方法：采用5个动、静脉双灌注成人尸头标本(共10侧)进行解剖学研究。在标本上进行经鼻内镜下暴露全程鼻泪管及泪囊，观察鼻泪管-泪囊切除过程的解剖标志和毗邻关系。结果：10侧泪囊-鼻泪管的解剖显示全部泪囊均位于鼻丘的前方稍外侧，泪囊顶基本和鼻丘顶平齐，泪囊体大部分位于中鼻甲腋窝水平线上方。泪囊窝后内壁由泪骨构成，泪骨后内方与鼻丘气房相邻。泪囊底向下移行为膜性鼻泪管进入骨性鼻泪管，鼻泪管在鼻腔外侧壁的投影位于钩突垂直部前缘前方约3~7mm。鼻泪管下鼻道开口距离下鼻甲前端的距离为(16±3)mm。泪囊长度为(13.8±1.8)mm，鼻泪管长度为(23.2±3.6)mm。结论：经鼻内镜入路可充分暴露和切除全程鼻泪管和泪囊。本解剖研究展示的基本操作过程和解剖标志可为临床开展经鼻内镜鼻泪管-泪囊切除术提供解剖学参考。
Objective: By simulating transnasal endoscopic resection of nasolacrimal duct and lacrimal sac on cadaveric specimens with vascular perfusion, the basic process of this procedure and the anatomical relationship between nasolacrimal duct and lacrimal sac were explored, providing anatomical basis for clinical application. Methods: Five adult cadaver head specimens (10 sides in total) were used for anatomical study. The nasolacrimal duct and lacrimal sac were exposed under transnasal endoscopy, and the anatomical landmarks and their relationship with adjacent areas during the resection of nasolacrimal duct and lacrimal sac were observed. Results: Ten sides of nasolacrimal duct and lacrimal sac showed that all lacrimal sacs were located anterior and slightly lateral to the nasal mound. The roof of lacrimal sac was almost the same height as the roof of nasal mound. The body of lacrimal sac was almost located above the horizontal line of the middle turbinate axilla. The posterior inner wall of the lacrimal fossa was composed of lacrimal bone. The posterior inner side of the lacrimal bone was adjacent to the agger nasi cell. The bottom of the lacrimal sac moved downward as the membranous part of the nasolacrimal duct located in the bony part of the nasolacrimal duct. The projection of the nasolacrimal duct on the lateral nasal wall was located about 3–7 mm in front of the anterior edge of the vertical part of the uncinate process. The distance between the inferior meatus opening of the nasolacrimal duct and the anterior end of the inferior turbinate was (16±3) mm. The length of the lacrimal sac was (13.8±1.8) mm, and the length of the nasolacrimal duct was (23.2±3.6) mm. Conclusion: The transnasal endoscopic approach can fully expose and resect the nasolacrimal duct and lacrimal sac. The basic operation process and anatomical landmarks demonstrated in this anatomical study provide an anatomical reference for the clinical development of transnasal endoscopic resection of nasolacrimal duct and lacrimal sac.
目的：探讨医用自交联透明质酸钠凝胶对鼻内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryocystorhinostomy，En-DCR)后的影响。方法：将219例单侧慢性泪囊炎(chronic dacryocystitis CD)患者随机分为医用自交联透明质酸钠凝胶组(A组)和对照组(B组)。所有患者行En-DCR。A组将医用自交联透明质酸钠凝胶填充吻合口，B组不做任何处理。随访12个月。比较创面黏膜上皮化、肉芽形成情况、渗血情况及吻合口通畅成功率。结果：A组98例，B组102例。随访2周，A组86例患者鼻腔吻合口黏膜上皮完整，B组77例患者鼻腔吻合口黏膜上皮完整。随访12个月，A组有7例患者存在瘢痕(7.1%)，8例患者出现肉芽肿(8.2%)，而B组有17例患者存在瘢痕(16.7%)，18例患者出现肉芽肿(17.6%)。两组瘢痕形成及出现肉芽肿差异均有统计学意义(P<0.05)。A组的吻合口通畅成功率达到90.8%(89/98)，而B组的成功率为78.4%(80/102)(P<0.05)。B组患者术后渗血情况A组相当(P>0.05)。结论：医用自交联透明质酸钠凝胶填充吻合口可通过促进En-DCR术后吻合口黏膜上皮愈合和降低伤口瘢痕及肉芽肿生成率，提高En-DCR治疗CD的成功率。
Objective: To investigate the effect of medical self-crosslinking sodium hyaluronate gel on endonasal endoscopic dacryocystorhinostomy (En-DCR). Methods: A total of 219 patients with unilateral chronic dacryocystitis (CD) were selected and randomly divided into two groups: medical self-crosslinking sodium hyaluronate gel group (group A) and control group (group B). All patients underwent En-DCR. Group A received medical self-crosslinking sodium hyaluronate gel filling the ostium at the end of En-DCR, whereas group B received no treatment. Patients were followed-up for 12 months. The mucosal epithelialization of the wound, the granulation formation, bleeding, and the success rate of ostial patency were compared in the two groups. Results: Our study included 98 patients in group A and 102 patients in group B. After 2 weeks, the number of absorbable hemostatic patients who had intact mucosal epithelium lining the ostia was 86 in group A and 77 in group B. At 12 months follow up, there were 7 patients with scar (7.1%) and 8 patients with granuloma (8.2%) in group A, compared with 17 patients with scar (16.7%) and 18 patients with granuloma (17.6%) in group B. There were significant differences in scar formation and granuloma between the two groups (P<0.05). The success rate of anastomotic patency reached 90.8% (89/98) in group A whereas the success rate was 78.4% (80/102) in group B (P<0.05). The situation of postoperative bleeding in group B was similar to that in group A (P>0.05). Conclusion: The medical self-crosslinking sodium hyaluronate gel can improve the success rate of En-DCR treatment of CD through promoting the healing of anastomotic mucosa and reducing the rate of wound scar and granuloma formation.
眶尖部肿瘤为眼科罕见疾病，但因其所处位置特殊，对机体，特别是视神经功能危害极大，错误的诊断、不规范合理的治疗不仅不能解决问题，甚至会对机体造成严重的不可挽回的损害。目前针对眶尖部肿瘤的诊断、治疗多建立在医生的主观认知与经验的基础上，尚未达成共识。本文通过分析眶尖部肿瘤的临床特点，结合以往漏诊、误诊、误治的临床案例，阐述眶尖肿瘤正确诊断的关键要点；同时，结合不同临床案例，客观分析治疗方案，尤其是手术方式、路径，为眶尖部肿瘤的合理化治疗提供依据，以期规范眶尖部肿瘤的诊断和治疗，提高治疗成功率。
Although orbital apical tumor is a rare ophthalmic disease, its special location can cause great harm to the body, especially to the function of the optic nerve. Misdiagnosis and improper treatment are not only unable to solve the problem, but also irretrievably harmful to the body. At present, there is no consensus on the diagnosis and treatment of orbital apical tumors, which are mostly based on subjective cognition and experience of doctors. In this paper, the clinical characters of orbital apical tumors were analyzed through the past clinical cases of misdiagnosis and mistreatment, and the key points of proper diagnosis of orbital apical tumors were expounded. Meanwhile, by combining with different clinical cases, the treatment plans, especially the surgical approaches, were analysed to provide a basis for the appropriate treatment of orbital apical tumors, in order to standardize the diagnosis and treatment of orbital apex tumor, and improve the success rate of treatment.
Abstract: Submacular haemorrhage (SMH) is a sight threatening complication that can occur in exudative age related macular degeneration (AMD), but has been described to occur more frequently in eyes with polypoidal choroidal vasculopathy (PCV). Left untreated, SMH carries a grave visual prognosis. Thus, expedient diagnosis and effective management of this complication is of paramount importance. The treatment strategies for SMH include (I) displacement of blood from the fovea, usually by injection of an expansile gas; (II) pharmacologic clot lysis such as with recombinant tissue plasminogen activator (rtPA); and (III) treatment of the underlying choroidal neovascularization (CNV) or PCV, such as with anti-vascular endothelial growth factor (anti-VEGF) agents. These three strategies have been employed in isolation or in combination, some concurrently and others in stages. rtPA has demonstrable effect on the liquefaction of submacular clots but there are remaining uncertainties with regards to the dose, safety and the timing of initial and repeat treatments. Potential side effects of rtPA include retinal pigment epithelial toxicity, increased risk of breakthrough vitreous haemorrhage and systemic toxicity. In cases presenting early, pneumatic displacement alone with anti-VEGF may be sufficient. Anti-VEGF monotherapy is a viable treatment option particularly in patients with thinner SMH and those who are unable to posture post pneumatic displacement.
Abstract: Submacular haemorrhage (SMH) is a sight threatening complication that can occur in exudative age related macular degeneration (AMD), but has been described to occur more frequently in eyes with polypoidal choroidal vasculopathy (PCV). Left untreated, SMH carries a grave visual prognosis. Thus, expedient diagnosis and effective management of this complication is of paramount importance. The treatment strategies for SMH include (I) displacement of blood from the fovea, usually by injection of an expansile gas; (II) pharmacologic clot lysis such as with recombinant tissue plasminogen activator (rtPA); and (III) treatment of the underlying choroidal neovascularization (CNV) or PCV, such as with anti-vascular endothelial growth factor (anti-VEGF) agents. These three strategies have been employed in isolation or in combination, some concurrently and others in stages. rtPA has demonstrable effect on the liquefaction of submacular clots but there are remaining uncertainties with regards to the dose, safety and the timing of initial and repeat treatments. Potential side effects of rtPA include retinal pigment epithelial toxicity, increased risk of breakthrough vitreous haemorrhage and systemic toxicity. In cases presenting early, pneumatic displacement alone with anti-VEGF may be sufficient. Anti-VEGF monotherapy is a viable treatment option particularly in patients with thinner SMH and those who are unable to posture post pneumatic displacement.
Abstract: Dry eye disease is the most prevalent ocular surface disease in eye clinics. The deficiency of tears is regarded as one of the main pathogenic factors for this disease. Due to the fact that the components of tears are still far beyond our knowledge, the restoration of physiological tears remains the optimum choice for dry eye patients. However, the traditional way to stimulate tear production by systemic administration of muscarinic agonists usually encounters severe side effects. Recently, Nakamachi and colleagues reported that PACAP, a native neurotransmitter present in tear fluid, could stimulate main lacrimal gland secretion and relieve dry eye-like symptoms in PACAP knockout mice. The finding of PACAP and its underlying mechanisms suggest a new modality for dry eye treatment via targeted topical tear stimulations.
Abstract: Dry eye disease is the most prevalent ocular surface disease in eye clinics. The deficiency of tears is regarded as one of the main pathogenic factors for this disease. Due to the fact that the components of tears are still far beyond our knowledge, the restoration of physiological tears remains the optimum choice for dry eye patients. However, the traditional way to stimulate tear production by systemic administration of muscarinic agonists usually encounters severe side effects. Recently, Nakamachi and colleagues reported that PACAP, a native neurotransmitter present in tear fluid, could stimulate main lacrimal gland secretion and relieve dry eye-like symptoms in PACAP knockout mice. The finding of PACAP and its underlying mechanisms suggest a new modality for dry eye treatment via targeted topical tear stimulations.
近年来，由于经济社会不断发展，社会压力增大，人们精神障碍和干眼的发病率不断增加，这既影响人们身心健康，也给社会经济造成一定负担。大量研究表明精神障碍与干眼显著相关，精神障碍是干眼的独立危险因素之一。然而在临床工作中，精神障碍与干眼间的关系在过去一直未受到重视，本文将从精神障碍与干眼关联性入手，探讨其中介作用，总结了精神障碍因素影响干眼症状和体征分离，并进一步倡导跨学科综合管理来治疗干眼，形成对干眼的正确感知并降低疼痛及健康焦虑水平，以期为干眼临床诊疗提供新的视角。
In recent years, due to the continuous development of economy and society and the increasing social pressure, the incidence rate of mental disorders and dry eyes is increasing, which not only affects people’s physical and mental health, but also creates a certain burden on the social economy. A large number of studies have shown that mental disorder is significantly related to dry eye, and mental disorder is one of the independent risk factors of dry eye. However, in clinical work, the relationship between mental disorder and dry eye has not been paid attention in the past. This paper will start with the correlation between mental disorder and dry eye, explore the mediating effects, summarize the mental disorder factors that affect the separation of symptoms and signs of dry eye, and further advocate interdisciplinary comprehensive management to treat dry eye, form a correct perception of dry eye and reduce the level of pain and health anxiety, In order to provide a new perspective for clinical diagnosis and treatment of dry eye.
鼻内镜外科技术延伸到鼻眼相关疾病的诊断和治疗已经有二十余年的历史。随着鼻眼相关解剖研究、影像诊断技术和手术器械的进步和手术临床经验的积累，大量临床和基础研究不断涌现，逐渐形成了相对成熟的内镜鼻眼相关外科理论与实践体系。本文概述了内镜鼻眼相关外科的发展现状，对几种主要手术提供经验总结并提出展望。
Nasal endoscopic surgery technology has gradually developed and involved into the diagnosis and treatment of nose-eye related disease for more than 20 years. With the improvement of anatomical studies on nose-eye, imaging diagnostic technology and surgical instruments, the accumulation of surgical clinical experience, as well as the increasing emergence of a large number of clinical and basic studies on endoscopic rhino-orbital related surgery, a well-established theoretical and practical system of endoscopic nose-eye surgery has gradually been formed. This article summarized the development of endoscopic rhino-orbital surgery, and the advantages and limitations of several major surgical methods. Also, the further research was prospected.
