Video-Endoscopic Findings of Opening after DCR and CDCR: Elucidation for the Mechanism of Passive Tear Drainage

淚囊吻合術後之內視鏡所見：被動性淚液引流機制之闡述

康孟喆(Mon-Te Kahn)

《中華民國眼科醫學會雜誌》 35卷3期 (1996/09) Pp. 264-270

https://doi.org/10.30048/ACTASOS.199609.0002

摘要

成功之淚囊鼻腔吻合術後，抑或結膜淚囊鼻腔吻合術後，所呈現之「功能性」阻塞，乃意指暢通的淚道其淚液引流之功能受損。此「功能性」阻塞可能肇因於淚幫浦功能之喪失，或是淚囊或引流瘦管之局部阻塞。先前之研究，已認定淚幫浦功能之喪失。然而本文嘗試解釋吻合術後，被動性淚液引流之角色。被動性淚液吸引之力量，可藉由文氏管模型來解釋。
電視型內視鏡及錄放影裝置用來記錄六例淚囊鼻腔吻合術患者之瘦管開口，二例結膜淚囊鼻腔吻合術患者之瓊斯氏管開口。其後以稀釋之龍膽紫灌注之，再於相同位置比較之。八位患者並告之以眨眼動作，並由鼻孔呼吸。於此同時，以內視鏡觀察開口附近之鼻腔黏膜。
相同之發現顯示，淚液及稀釋龍瞻紫之引流於吸氣所得之助益較呼氣為佳。鼻腔黏膜之潤澤反射向內甚於向外。吸氣時，經由上鼻道之氣流，於瘻管開口形成負壓，此力量將淚液曳引流入上鼻道，同時由黏膜纖毛之組識結構助暢其流。

並列摘要

”Functional block” after successful dacryocystorhinostomy [DCR] or conjunctivodacryocystorhinostomy [CDCR], implies that impaired lacrimal drainage function in a patent lacrimal drainage system. The postoperative functional block may be indicative of failure of lacrimal pump or of partial obstruction in the lacrimal sac or the drainage fistula. The failure of lacrimal pump has been confirmed by previous researcher. However, this study tries to elucidate the role of passive tear drainage after DCR and CDCR. Passive tear suctioning force can be demonstrated by a Venturi tube model.
Videoendoscope [LASE kit by Coherent Co.] and recorder are applied to observe the fistula opening of six cases postDCR, and the ostium of Jones' tube for two cases postCDCR. Later, these figures may be compared with the same sites, when the diluted Gentian Violet is irrigated. These patients are told to blink their eyes and to respire through their noses. The nasal mucosa adjacent to the opening is closed in upon with endoscope for its details during this maneuver.
Those identical findings reveal that the drainage of tear and diluted Gentian Violet are facilitated by inspiration rather than by expiration. The lustrous shining of nasal mucosa directs inward rather than outward.
The inspired air flowing through the superior nasal meatus results in a negative pressure. This force drags in tear flow which is facilitated by mucociliary apparatus.

並列關鍵字

Videoendoscope ； Fistula opening ； Venturi tube ； Bernoulli's principle