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Dacryocystorhinostomy failure and Countermeasures
Xia Ling Zhang to be electric First People's Hospital of Changde City, Hunan Changde 415 003 771 Wu Yi silver electric Quxia Ling Zhang to be the first People's Hospital of Changde City, Hunan Changde ,---- a, - a U.S. Key words tears cysticercosis / diagnosis; dacryocystorhinostomy removal hole surgery / surgery; removal of bone hole failure / abnormal _ Well complications plug / concurrent; - / complications heartfelt wish to circle the book shelf of China Key words: R777.23 Document code: B Article ID: 1002. 3429 (2000) 06-0461-01 dacryocystorhinostomy is recognized as the best method of treatment of chronic dacryocystitis, one of the success rate was 92], but still bound to be some technical errors and complications. Our hospital in March 1990 and July 1999 in line l2 dacryocystorhinostomy 230 cases, failed 2l cases, error rate 9,13,[link widoczny dla zalogowanych], analyze the reasons for its mistakes, and explore countermeasures. Clinical data 1 1.1 General Information of this group are in the hospital or outside the hospital did dacryocystorhinostomy patients, 9 males and 12 females; aged from 12 to 54 years, mean 33 years old, are monocular. Treatment time is after 3 months to 2 years, poor flushing, and accompanied that lacrimal tears. Table 1.2 l failure and treatment failure praise an operation bearing in mind the results of treatment of 1.3 square blast nasal mucosa in 1 patient with untreated severe atrophy, the patients were re-surgical treatment of more than 3 months after the review, consistent were successful. 2 to discuss the size of the hole 2.1 osteoblasts, 6 cases because of this group made mistakes and lost bone hole, accounting for 28.6. Hole is made of bone surgery can be seen the key to success, first bone hole is large enough, only enough bone hole, the nasal mucosa was exposed to the full, easy to fit, and less prone to fit 121 block. But not too large, so as not to affect the nasion Department, or even result in Biliang collapse, and the bone hole caused by the General Assembly before the lip is too large, but also prone to cause subsidence of the former lip compared with the posterior lip stick, generally 1.5cm ĄÁ 2.0cm appropriate. Improper bone hole location is not conducive to mucosa anastomosis ˘ň]. We usually tear after the first crest at the top of the lower open on low bone wall leads to the nasal bone, and then tear the middle of the center before the crest, with a careful bite rongeur addition to bone, rather than chisel and hammer, so not only reduces the vibration, bone hole size,[link widoczny dla zalogowanych], location is also moderate. 2.2 Treatment of anastomotic stoma leading to mishandling of another important reason for surgical failure, this group accounted for 23.8. We think that in addition easy to make mistakes in osteoblast hole anastomotic obstruction,[link widoczny dla zalogowanych], the treatment of anastomotic also important. Such as the anterior lip of the anastomosis suture tension can not be too large, or premature loss of suture is easy; not be too long before the lips too wide, too long and too loose will cause before and after lip lip close to the adhesion. The former can be free and cut the bottom to solve the lacrimal sac, which was argued before the match when the suture through the lips and tears before the crest above the margin of the periosteum and orbicularis muscle or other soft tissue and then tie a knot]. We generally replaced with gelatin sponge anastomotic vaseline gauze, let the natural absorption, so that we can avoid adhesions around the lips, but also to remove the blood pumping when the vaseline gauze. In addition, machines of blood clots,[link widoczny dla zalogowanych], granulation and scar tissue can also cause erythema consistent with obstruction, to prevent blood clots after washing machine of time, ask the patient whether preoperative physical marks erythema, very important. 2.3 duct injury should be carefully examined before surgery, small tubes of tears, tears to the lacrimal duct stenosis Explorer catheter retention, after flushing, flushing method to master the correct, non-violent force, in order to avoid the formation of false passage or injury lacrimal duct,[link widoczny dla zalogowanych], blocking the formation of adhesions. 2.4 Treatment of lacrimal sac lacrimal sac mucosa in order to avoid this mistake is not cut, preferably under the guidance probe lacrimal incision and normal saline can be used to further confirm lacrimal. 2.5 infections in addition to conventional antibiotics, we believe that gelatin sponge coated with antibiotic ointment, and then fill in the agreement of its 121, or postoperative day 5 with eye drops lacrimal irrigation, prevention of infection may be helpful.
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