泪道肿瘤是比较罕见的泪道疾病。文献报道有超过55%的泪道肿瘤为恶性肿瘤，如果肿瘤不能完全切除或已经发生转移，可能会使复发率和死亡率增加。故临床上对表现为泪囊肿物的病例应详细检查，比如眼眶彩色多普勒超声、计算机断层扫描(computed tomography, CT)及磁共振成像(magnetic resonance imaging, MRI)检查，必要时行增强扫描，有条件还可以进行泪道内镜检查，充分预估病情，设计合理的手术入路和切除范围。如肿物较大或病情复杂，经过皮肤或者鼻内镜下入路作单一切口不能完整切除，可以内外路联合手术，以获得良好的视野，对肿物进行充分的游离分离，进行合适的切除。文章汇报了通过皮肤切口联合鼻内镜入路完成的2例泪道肿瘤切除术，1例术后病理为良性的乳头状瘤，术后5个月时复查未见复发，长期观察；另一例为NUT癌，确诊后患者已经至肿瘤科接受了化学治疗。提示表现为泪囊肿物的病例在术前应完善眼眶影像学检查，怀疑为恶性肿瘤时应完善全身重要脏器的检查，以充分评估病情。对于有手术指征的应选择合适的手术方案，尽量完整切除。术后应长期随访，以早期发现复发和转移，及时治疗。

Lacrimal tumors are a relatively rare disease of the lacrimal system. According to the literature, more than 55% of lacrimal tumors are malignant tumors. If the tumor cannot be completely removed or has already metastasized, it may increase the recurrence rate and mortality rate. Therefore, in clinical practice, if a case of a mass in the lacrimal sac is encountered, a thorough examination should be performed, such as orbital ultrasound scan, CT and MRI with or without contrast enhancement, and endoscopic examination of the lacrimal duct, if possible. The condition should be fully assessed to design a reasonable surgical approach and the extent of surgical resection. If the lesion is large or the condition is complex, a single incision through the skin or endoscopic approach may not be able to completely remove it, and an combined approach can be used to obtain a good view and fully dissect and separate the lesion for appropriate resection. This article reports two cases of lacrimal tumor resection performed through a skin incision combined with an endoscopic approach, one of which had a postoperative pathological diagnosis of benign papilloma and no recurrence was observed.5 months after surgery and Long-term follow-up is planned. The other case was NUT carcinoma. The patient had received chemotherapy in the oncology department of the general Hospital after diagnosis. It is suggested that the imaging examination of the orbit should be improved in the case of lacrimal tumor before operation, and the examination of the main organs of the body should be perfected when malignant tumor is suspected, so as to fully evaluate the condition. For the case with surgical indications, the appropriate surgical plan should be selected and the complete resection should be carried out as much as possible. Long-term follow-up should be carried out after surgery, so that recurrence and metastasis can be detected early, and timely treatment can be carried out.

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.