成功的淚囊鼻腔吻合術後溢淚問題之探討

Epiphora after a Successful DCR

馬俐(Lih Ma) ； 陳美玲(Mei-Lin Chen) ； 高錦弘(Ching-Hong Kao)

《中華民國眼科醫學會會刊》 30卷2期 (1991/12) Pp. 84-92

https://doi.org/10.30048/ACTASOS.199112.0058

摘要

為了探究在成功的淚囊鼻腔吻合術後，少數患者仍有溢淚的問題。本文共收集了351人，397眼（原為鼻淚管阻塞的病患）經過淚囊鼻腔吻合術後，追蹤一年以上，且淚矽小管已摘除的病患，其中輕微溢淚及會溢淚的共有41人，45眼，佔11.8%。
本文即針對各個可能影響手術結果的因素加以分析。包括患者的年齡、性別、發病時間、發病原因、淚點的完整性、淚小管暢通性、淚囊大小，以及一些因不同的手術方法或術後處置而引起的差異，如手術後鼻內塞料留置的時間長短，術後淚矽小管置留時間長短，淚囊與鼻黏膜間瓣膜縫合方式，骨孔位置的高低，開刀的年份各項，分別統計分析。發現只有在息者的年齡、性別、發病原因、術前淚囊大小四項有統計學上的意義。其他各項並無法找出統計學上相關的原因。
經過淚囊閃爍照像，呈現出功能性阻礙的現象。在41人，45眼術後溢淚的患者中有19人，20眼又將淚矽小管放入，所有的患者症狀皆獲得改善。有三位病患將鬆弛的結膜切除縫合後，溢淚現象也改善。因此在結論中推測此種現象乃因經過鼻淚管手術後，淚囊完全被打開，淚囊唧筒的效用降至零，影響到淚點將淚水吸入淚小管的動作，因而呈現出溢淚的現象。

並列摘要

Dacryocystorhinostomy is a well-developed operation. Reported success rate of this operation was about 90% to 95%. However, some patients still complained of tearing even after a successful DCR.
In 397 cases with anatomical success, 45 cases complained of tearing after removal of the silicone tube. In this study, we researched every possible influence to the results including: age, sex, duration of symptoms, etiology, integrality of punctum, patency of canaliculae, volume of sac, duration of nasal patching remains, duration of silicone tube remains, kind of flap, and location of osteotomy site. Statistically significiances can be found in age, sex, etiology and the volume of sac.
Patent lacrimal drainage systems can be proved by irrigation, however, lacrimal scintilla-graph showed delayed drainage of the isotopes. This epiphora may be corrected by secondary silicone intubation.
The main factor of this phenomenon was loss of lacrimal pumping action after DCR. The lacrimal sac was surgically permanently opened on its nasal side after the operation. The sac could not be distended. Canalicular pumping theory has evalved to explain the mechanism of tear drainage.

並列關鍵字

Epiphora ； Dacryocystorhinostomy ； Lacrimal pump ； Functional block