获得性泪囊黏液囊肿的临床特征、影像学表现和内镜手术治疗效果

Clinical profile, imaging findings and endoscopic surgical treatment of acquired lacrimal sac mucocele

摘要:

目的 探讨获得性泪囊黏液囊肿（ALSM）的临床特征、影像学表现和内镜下泪囊鼻腔吻合术（En-DCR）的治疗效果。方法 回顾性分析2016年1月－2021年3月于温州医科大学附属眼视光医院就诊并接受En-DCR联合双管人工泪管植入术治疗的63例（63眼）ALSM患者的术前和术后12个月随访资料，记录并分析纳入患者的临床特征、影像学表现和内镜下手术治疗效果。最终纳入57例患者（男21例，女36例），年龄25～71岁，平均（52.89±11.66）岁，右眼30眼，左眼27眼。所有患者均有溢泪和溢脓的泪道阻塞病史。结果 CT检查发现泪囊扩大，相邻骨质没有破坏。MRI检查显示泪囊扩大，囊内的液体被扩大的泪囊壁与周边组织分隔。内眦部泪囊区肿块在手术切开泪囊时明显缩小，其皮肤面的轻度肿胀在术后1周内完全消失。术后随访12个月，En-DCR的解剖成功率为92.98%（53/57），功能成功率为89.47%（51/57），未出现囊肿复发、视力下降和感染等并发症。结论 ALSM患者均有泪道阻塞病史。影像学检查对ALSM的诊断有参考价值。En-DCR联合人工泪管植入治疗ALSM，安全有效，值得临床推广。

Abstract:

Objective To report the clinical features, imaging findings and endoscopic dacryocystosinostomy (En-DCR) of acquired lacrimal sac mucocele (ALSM).Methods 63 patients (63 eyes) with ALSM treated with En-DCR combined with bicanalicular silicone tube intubation from January 2016 to March 2021 were reviewed. The clinical features, imaging findings, and surgical treatment of the included patients were analyzed by preoperative examination and 12 month postoperative follow-up. Fifty-seven patients (21 males and 36 females) were enrolled in this study at last, including 30 right eyes and 27 left eyes, 25 ~ 71 years old, with an average age of (52.89 ± 11.66) years old. All eyes with history of epiphora and purulent secretion.Results CT examination revealed enlargement of the lacrimal sac, but no destruction of the adjacent bone. MRI imaging showed enlargement of the lacrimal sac, fluid collection separated from adjacent tissues by a thin rim, corresponding to mucocele in the sac and increase in the sac diameters in all analyzed cases. The mass was found to shrink significantly when the lacrimal sac was opened during the surgery, and the swelling was completely relieved within 7 days post-operation. After 12 months of follow-up, the anatomical success rate of En-DCR was 92.98% (53/57), the functional success rate was 89.47% (51/57), no complications such as mucocele recurrence, diminution of vision and infection were found.Conclusion All the patients with ALSM had a history of previous lacrimal duct obstruction. Imaging examinations are valuable for the diagnosis of ALSM. En-DCR for ALSM is safe and effective, and worthy of clinical promotion.