磁共振泪道水成像在溢泪诊治中的应用

Application research of magnetic resonance hydrography in diagnosis and treatment of epiphora

摘要:

目的：研究磁共振泪道水成像(MRH)技术在溢泪诊治及预后评估中的应用价值。

方法：招募溢泪患者40例52眼，于治疗前对所有病变泪道行MRH检查，结合泪道冲洗探查明确溢泪病因及病变局部解剖、功能异常，制定相应治疗方式，并于治疗后再次行MRH检查对疗效进行评估。

结果：本组中有10例14眼为功能性溢泪，余30例38眼均为泪道梗阻； 经MRH检查显示梗阻水平分别位于泪小管(9例9眼)、鼻泪管(18例26眼)、泪小管+鼻泪管(3例3眼)且部分病变侧泪囊呈不同程度扩张、变形； 经冲洗探查及眼科查体可知，部分遇硬性阻抗(3例3眼)、泪小点表面红肿(3例3眼)； 冲洗可见脓性、浆液性、粘液性分泌物； 综合所有检查信息制定3种手术方案； 术后复查MRH表现为泪道通畅、泪囊不同程度缩小。

结论：本研究将MRH检查信息与泪道冲洗探查结果进行综合分析，针对患者的个体化情况制定多种差异性手术方案并以MRH评估其疗效，为临床提供了一种安全、准确、实用的泪道病变诊疗、评估方法。

Abstract:

AIM:To study the application value of magnetic resonance hydrography(MRH)technology in diagnosis, treatment and prognostic evaluation of epiphora.

METHODS: Before treatment, 40 patients(52 eyes)with epiphora underwent MRH examination, flushing and probing of lacrimal ducts to ascertain the causes of lacrimal duct obstruction, and identify the local anatomical changes and dysfunction. Then a individualized treatment plan was developed on the basis of comprehensive analysis of the aforementioned examination results. And then, after the operation, the therapeutic effect was evaluated by reexamination of MRH and flushing and probing of lacrimal ducts.

RESULTS: Ten of all enrolled patients(14 eyes)had functional epiphora, the remaining 30(38 eyes)had lacrimal duct obstruction. MRH examination showed that the level of obstruction was located in lacrimal canaliculus(9 cases 9 eyes), ductus nasolacrimalis(18 cases 26 eyes), lacrimal canaliculus plus ductus nasolacrimalis(3 cases 3 eyes), and some dacryocysts of the disersed side were dilated and deformed in varying degrees. The results from ophthalmological examination and combined examination of flushing and probing of lacrimal ducts showed that some could be touched scleroid block(3 cases 3 eyes)and some soft tissue of lacrimal punct area were red and swollen(3 cases 3 eyes). There were three kinds of secretions, including purulent, serous and mucous, from flushing of lacrimal ducts. Three different surgical programs had been formulated by combining all the inspection information. Postoperative MRH showed that the lacrimal ducts had been unobstructed and the dacryocystis had been narrowed in varying degrees.

CONCLUSION: A comprehensive analysis of the inspection information was taken from MRH and the results from flushing and probing of lacrimal ducts, and combined the individual patient's condition, the ophthalmologists formulated some differentiated and individualized surgical programs, and evaluated the curative effect. According to the study, we have provided a set of safe, accurate and practical methods of inspecting the lacrimal duct obstruction and evaluating their curative effect.