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：探讨完善泪道成形+义管植入日间手术患者的延续性护理对预防义管意外脱管的重要作用。方法：收集我科2016年1月至12月实施了标准延续性护理的泪道成形+义管植入日间手术患者的意外脱管情况。结果：泪道成形+义管植入日间手术患者随访期间没有发生医源性脱管，有9例9眼带管期间在院外发生脱管，意外脱管率为2.6%。结论：做好泪道成形+义管植入日间手术患者的延续性护理，有效降低义管意外脱出率，有利于患者康复。
Objective: To explore the important role of continuous nursing of the patients with day surgery of lacrimal duct forming combined tube implantation in the aspect of accident prevention to take off the tube. Methods: The information of the patients from Jan. to Dec. 2016 with accident the tube’s takeoff after carrying out the standard continuity of care were collected. Results: There was no iatrogenic but 9 eyes of 9 patients accidentally take off the tube during follow-up period. Accidental decannulation rate was 2.6%. Conclusion: Continuous care of the patients with day surgery of lacrimal duct forming combined tube implantation can effectively reduce the tube accidentally removal rate and be beneficial to patients’ recovery.
原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction，PANDO)是泪道阻塞性疾病中最常见的一类，好发于中老年女性，是眼科临床上的常见病、多发病，常继发急性或慢性泪囊炎的症状和体征，严重影响患者的日常工作和生活。本文对近年来PANDO可能的发病机制相关的研究进展、亟待解决的问题及未来研究的热点方向作一综述，旨在进一步加深对泪道阻塞性疾病发生发展的认识。
Primary acquired nasolacrimal duct obstruction (PANDO), which mainly occurs in the middle-aged and elderly women, is the most common type of obstructive diseases of the lacrimal duct, and it is also a common and frequently-occurring disease in ophthalmology. It constantly occurs secondary to various symptoms and signs of acute or chronic dacryocystitis, which seriously affects the daily work and life of patients. This article summarizes the research progress on the possible pathogenesis of PANDO in recent years, the urgent problems to be solvedand the hot research directions in the future, aiming to further deepen the understanding of the occurrence and development of lacrimal obstructive diseases.
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.
