目的：探讨改良的外路泪囊鼻腔吻合术式联合泪道置管治疗泪囊黏液囊肿的临床疗效。
方法：对23例（23眼）泪囊黏液囊肿行改良式泪囊鼻腔吻合术，并联合泪道置管，术后行泪道冲洗，并观察泪溢情况。

结果：23例患者，1例术中改为泪囊摘除术，20例完成12个月的追踪观察治疗，1例术后6个月失访，1例12个月时失访。随访1个月，22例患者术后泪囊肿均消失，外观明显改善；随访12个月，20例患者中18例溢泪症状完全消失，所有患者泪道冲洗通畅，仅1例患者因泪溢症状对手术疗效不满意。

结论：改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿，具有良好的临床效果值得推广。

Purpose: To investigate the eficacy of modified external dacrocystorhinostomy (DCR) with intubation in the treatment of lacrimal sac cys.

Methods: Twenty-three lacrimal sac cyst cases (23 eyes) were enrolled and treated with DCR technique and tube intubation. The success was assessed based on lacrimalirrigation and symptomatic relief of epiphora.

Results: Among 23 patients, surgery was intenupted and converted to dacryocystectomy in l case, thus surgery was successfully performed in 22 cases. Among them, 1 case lost follow up at 6 month, 1 case lost follow up at 12 month. At 1 month visit, lacrimal sac cyst disappeared in 22 cases. At 12 month visit, epiphora was completed relieved in 18 out of 20 cases, irrigation indicated no obstruction in all 20 cases.

Conclusions :The modified DCR technique with intubation has satisfactory outcome for lacrimal sac cyst.

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.