| Objective: To study the indications,technique and diagnostic utility of computed tomographic dacryocystography(CTDCG),and observe the short to medium term effectiveness of nasolacrimal duct obstruction by silicone tube retrograde intubation.Methods: A total of 14 patients 16 eyes underwent CTDCG.They were diagnosed as chronic dacryocystitis in the First Affiliated Hospital of the Dalian Medical University from August 2015 to February 2016.The image quality and level of discomfort during the examination were evaluated.The size of lacrimal sac and the length from the debouch of canalis nasolacrimalis to the blocking were measured.The procedure of nasolacrimal duct obstruction by silicone tube retrograde intubation was performed in local anesthesia and observe the short to medium term effectiveness.All the data were analysised by SPSS 22.0,P < 0.05 was refered to statistically significant difference.Results: 1.This group of data shows: female in 14(87.50%),2 cases were male(12.50%).Both eyes had similar incidence;the minimum age is 39 years old and the biggest is 79.The mean age was 55.29±12.66 years old.The age from 40 to 60 was a high-risk age.12 patients were monocular disease,accounting for 85.71%,the incidence of left and right eye is similar.2.The images of CTDCG show:(1)The normal lacrimal passage presents as a smooth and irregular duct with clear outline,good filling and normal size,the contrast medium can reach the inferior nasal meatus successfully.There is no autoradiographs in superior lacrimal canaliculi and conjunctival sac when the contrast medium is injected through the inferior lacrimal canaliculi.(2)The obstructed lacrimal passage of Chronic Dacryocystitis is nasolacrimal duct,the image has the following typical signs: contrast reflux,filling defects,dilation of the proximal lumen,and so on.The development of lacrimal sac wall is not smooth,and the inflammatory changes of surrounding soft tissue are found in the inflammatory phase or the previous acute development.Fistula between the facial skin and the lacrimal sac can be observed when the sac ruptures,the size of lacrimal sac is several times bigger than the normal at the same time.The contrast medium becomes fine line or beaded line at the narrow of nasolacrimal duct.This group of data shows: angiographic images of the obstructive plane interface is significant,the obstruction site of most patients is from the junction of lacrimal sac and nasolacrimal duct to the nasolacrimal duct in the middle and lower 1/3.In this group,the length of lacrimal sac we measured is 6.25 ~ 27.50 mm,with the average 10.04 ±4.96 mm;the anteroposterior diameter is 5.70 ~ 10.0 mm,with the average 7.56 ± 1.40mm;the transverse diameter is 3.20 ~ 7.50 mm,with the average 5.37 ± 1.40 mm.The volume of lacrimal sac is 0.26±0.12cm3.There is statistical significant difference of lacrimal sac size between normal eyes and chronic dacryocystitis.3.Twelve cases(14 eyes)in this group of patients accept nasolacrimal duct obstruction by silicone tube retrograde intubation successfully.All the patients eased significantly after the operation.The lacrimal duct system was able to be irrigaeted,and there was no disconfort with eyes or noses.Conclusion:1.CTDCG can clarify the specific obstruction part of the chronic dacryocystitis and measure the size of the lacrimal sac from CT all levels.It can also show the paranasal sinus,maxillary sinus,the surrounding tissues and so on.It helps to evaluate operation difficulty and choose the most appropriate surgical procedure.2.Silicone tube retrograde intubation for treatment of nasolacrimal duct obstruction is safe and have a good effect with the help of CTDCG.CTDCG is well worth development. |
PDF Full Text Request