基于骨性鼻泪管走向的泪道CT造影三平面重组技术在面中部骨折致外伤性慢性泪囊炎诊治中的应用

周希彬; 王立华; 陶海; 白芳; 王朋; 王菲; 柳川

doi:10.3969/j.issn.2095-5227.2022.10.010

基于骨性鼻泪管走向的泪道CT造影三平面重组技术在面中部骨折致外伤性慢性泪囊炎诊治中的应用

Application of three-plane reconstruction of CT dacryocystography based on trend of nasolacrimal canal in diagnosis and treatment of traumatic chronic dacryocystitis caused by midfacial fracture

摘要

摘要:
背景面中部骨折导致的慢性泪囊炎病情复杂，普通泪道CT造影检查难以清晰准确地显示双侧鼻泪管全程。基于骨性鼻泪管走向的泪道CT造影三平面重组技术(three-plane reconstruction of CT dacryocystography based on the trend of nasolacrimal canal，CT-DCG-TPR-BTNC)可更清晰地显示泪道组织结构细节。
目的探讨CT-DCG-TPR-BTNC技术在面中部骨折致外伤性慢性泪囊炎的诊断及治疗中的应用效果。
方法回顾性分析2019年6月 - 2021年12月就诊于解放军总医院第三医学中心的22例外伤性慢性泪囊炎患者的临床及CT资料，患者均经过CT-DCG-TPR-BTNC检查，分析面中部骨折对泪道阻塞的影响，并在术中验证CT-DCG-TPR-BTNC检查结果的一致情况。
结果 22例患者中，男性10例(45.5%)，女性12例(54.5%)。年龄6 ~ 53(30.86 ± 12.02)岁。22例患者均患有外伤性慢性泪囊炎。病史3 ~ 180(37.32 ± 52.95)个月。所有患者经CT-DCG-TPR-BTNC检查发现均有面中部骨折及其导致的鼻泪管骨折。面中部骨折包括鼻骨骨折(21/22，95.5%)、眶壁骨折(19/22，86.4%)、颌面骨折(12/22，54.5%)、泪囊萎缩(2/22，9.1%)，并有1例颅底骨折。所有患者均行外路改良泪囊鼻腔吻合术，术中所见与CT-DCG-TPR-BTNC检查结果完全一致，符合率100%。患者均术中置入双泪小管置入式人工泪管，术后3 ~ 6个月取出人工泪管，随诊3 ~ 6个月后无复发。
结论应用CT-DCG-TPR-BTNC技术术前可充分评估临近组织的损伤，尤其是骨性鼻泪管损伤和解剖变异情况，可评估泪囊窝及鼻泪管损伤程度，对于指导手术方案的制订有重要临床价值。

Abstract:
Background Chronic dacryocystitis due to midfacial fracture is complex, and conventional CT dacryocystography cannot clearly and accurately display the bilateral nasolacrimal ducts. Three-plane reconstruction of CT dacryocystography based on the trend of nasolacrimal canal (CT-DCG-TPR-BTNC) can clearly display the detailed structure of the lacrimal duct. Objective To investigate the value of CT-DCG-TPR-BTNC in the diagnosis and treatment of traumatic chronic dacryocystitis caused by midfacial fracture.
Methods A retrospective analysis was performed for the clinical and CT data of 22 patients with traumatic chronic dacryocystitis admitted to the Third Medical Center of Chinese PLA General Hospital from June 2019 to December 2021, and all patients underwent CT-DCG-TPR-BTNC. The influence of midfacial fracture on lacrimal duct obstruction was analyzed, and the consistency in CT-DCG-TPR-BTNC results was validated during surgery.
Results Among the 22 patients, there were 10 male patients (45.5%) and 12 female patients (54.5%), with a mean age of 30.86±12.02 years (range, 6-53 years). All patients were diagnosed with traumatic chronic dacryocystitis, with a mean medical history of 37.32±52.95 months (range, 3-180 months). CT-DCG-TPR-BTNC showed that all patients had midfacial fracture and the resulting nasolacrimal duct fracture. Midfacial fracture included nasal bone fracture (21/22, 95.5%), orbital fracture (19/22, 86.4%), maxillofacial fracture (12/22, 54.5%), and lacrimal sac atrophy (2/22, 9.1%), and there was 1 patient with skull base fracture. All patients underwent modified external dacryocystorhinostomy, and intraoperative findings were consistent with the results of CT-DCG-TPR-BTNC, with a consistency rate of 100%. Artificial nasolacrimal ducts were placed into the bilateral lacrimal ductules for all patients and were then removed at 3-6 months after surgery, and no recurrence was observed after 3-6 months of follow-up.
Conclusion CT-DCG-TPR-BTNC can accurately evaluate the injury of adjacent tissue before surgery, especially bone injury of the nasolacrimal duct and anatomical variation, and assess the degree of injury of the lacrimal fossa and the nasolacrimal duct, which has an important clinical value in guiding the formulation of surgical plan.

HTML全文

参考文献(18)

施引文献

资源附件(0)