Pagella Fabio, Pusateri Alessandro, Matti Elina, Carena Paolo, Quiroa Luis, Antoniazzi Elena, Emanuelli Enzo
Department of Otorhinolaryngology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
Department of Ophthalmology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Policlinico San Matteo, University of Pavia, Pavia - Italy.
Eur J Ophthalmol. 2017 May 11;27(3):379-381. doi: 10.5301/ejo.5000917. Epub 2016 Dec 2.
Few studies have focused on the intranasal localization of the lacrimal sac during endoscopic dacryocystorhinostomy: landmarks in order to find the medial wall of the lacrimal sac have been described, but there is a lack of description of methods for the verification of the complete marsupialization of the lacrimal sac during surgery. In this report, we propose an easy and effective method for certain intraoperative identification of lacrimal sac.
A method in order to verify the effective marsupialization of the lacrimal sac is applied and described: to ensure that the opening of the sac in the nasal cavity is complete, the surgeon should identify the Rosenmuller valve, which is the end of the common canaliculus in the lacrimal sac. Continuous irrigation with saline solution through the inferior canaliculus can be useful to obtain a clean surgical area and to permit easy intraoperative identification of the valve.
Between 2007 and 2015, 193 endoscopic dacryocystorhinostomies were performed in our institutions. Postoperative surgical success at last follow-up (minimum 12 months) was 93.8% (181 out of 193 of cases). No major complications were observed.
Correct and complete exposure of the lacrimal sac during surgery is crucial for a good outcome: when the opening of the common canaliculus is identified, the surgeon is assured that the sac has been correctly and completely marsupialized inside the nasal cavity.
在内窥镜下泪囊鼻腔造口术中，很少有研究关注泪囊的鼻内定位：虽然已经描述了用于找到泪囊内侧壁的标志，但缺乏关于手术中验证泪囊完全袋形化方法的描述。在本报告中，我们提出了一种在术中确定泪囊的简便有效的方法。
应用并描述了一种验证泪囊有效袋形化的方法：为确保泪囊在鼻腔内的开口完整，外科医生应识别 Rosenmuller 瓣，它是泪囊中共同泪小管的末端。通过下泪小管持续用盐溶液冲洗有助于获得清洁的手术区域，并便于术中识别该瓣膜。
2007 年至 2015 年期间，我们机构共进行了 193 例内窥镜下泪囊鼻腔造口术。最后一次随访（至少 12 个月）时手术成功率为 93.8%（193 例中的 181 例）。未观察到重大并发症。
手术中正确且完全暴露泪囊对于取得良好效果至关重要：当识别出共同泪小管的开口时，外科医生可确保泪囊已在鼻腔内正确且完全袋形化。
