Cui Xinhan, Wang Yan
Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2024 Aug 1;14(8):5642-5649. doi: 10.21037/qims-24-541. Epub 2024 Jul 22.
An understanding of the anatomical structure is crucial for completing successful endoscopic dacryocystorhinostomy (DCR) surgery. This study aimed to precisely delineate the spatial relationship between the lacrimal sac and the agger nasi cell (ANC) and evaluate the impact of ANC on surgical strategies in endoscopic DCR.
This retrospective cross-sectional study included 110 Han Chinese patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) from January 2021 to June 2023. This study was conducted in Eye, Ear, Nose, and Throat Hospital of Fudan University and involved inpatient participants who were scheduled for DCR surgery under general anesthesia. Patients were consecutively enrolled. The patients underwent preoperative computed tomography-dacryocystography (CT-DCG), and contrast-enhanced images were used to locate the positions of the lacrimal sac and the common canaliculus. A dynamic approach was adopted to analyze the multiplanar CT imaging, facilitating a detailed assessment of the morphology of the lacrimal drainage system and potential overlap of the lacrimal sac. Patient ages and measured values are presented as the mean ± standard deviation, which were measured three times by the same observer and averaged for statistical analysis.
The prevalence of ANC in this study was 90.9% (100/110). Dynamic examination revealed that only 42.7% (47/110) of ANCs appeared as discrete cells, while the majority were connected to nearby sinus openings. Spatial analysis showed that in 57 out of 110 cases, ANCs were situated below the common canaliculus and not posterior to the lacrimal sac, indicating an overlap rate of 51.8%. Notably, our dynamic approach identified five critical cases of overlap below the level of the common canaliculus, which might have been missed by prior studies that used different methodologies.
More than half of the ANCs exhibited overlap with the lacrimal sac, suggesting a significant proportion may necessitate opening during endoscopic DCR procedures. ANCs are often interconnected with adjacent nasal sinuses, necessitating careful consideration in the decision to open the ANCs during surgery. The dynamic evaluation employed in CT-DCG effectively assessed the extent of ANC coverage over the lacrimal sac.
了解解剖结构对于成功完成内镜下泪囊鼻腔造口术（DCR）至关重要。本研究旨在精确描绘泪囊与鼻丘气房（ANC）之间的空间关系，并评估ANC对内镜下DCR手术策略的影响。
这项回顾性横断面研究纳入了2021年1月至2023年6月期间诊断为单侧原发性后天性鼻泪管阻塞（PANDO）的110例汉族患者。本研究在复旦大学附属眼耳鼻喉科医院进行，纳入了计划在全身麻醉下进行DCR手术的住院患者。患者连续入组。患者接受术前计算机断层扫描泪囊造影（CT-DCG），并使用增强图像定位泪囊和泪小管的位置。采用动态方法分析多平面CT成像，有助于详细评估泪道系统的形态以及泪囊的潜在重叠情况。患者年龄和测量值以平均值±标准差表示，由同一名观察者测量三次并取平均值进行统计分析。
本研究中ANC的患病率为90.9%（100/110）。动态检查显示，只有42.7%（47/110）的ANC表现为离散的气房，而大多数与附近的鼻窦开口相连。空间分析显示，在110例病例中的57例中，ANC位于泪小管下方且不在泪囊后方，重叠率为51.8%。值得注意的是,我们的动态方法识别出了5例泪小管水平以下的关键重叠病例，这可能是之前使用不同方法的研究所遗漏的。
超过一半的ANC与泪囊存在重叠，这表明在进行内镜下DCR手术时，可能有很大一部分需要打开。ANC常与相邻鼻窦相互连通，因此在手术中决定是否打开ANC时需要仔细考虑。CT-DCG中采用的动态评估有效地评估了ANC覆盖泪囊的范围。
