Dacryocystectomy

Lacrimal sac extraction is suitable for corneal infection after chronic dacryocystitis, or the patient is old and weak, the lacrimal sac is atrophy, or the nasal cavity is not suitable for anastomosis with lacrimal sac nasal cavity. The treatment of chronic dacryocystitis and nasolacrimal duct obstruction should be treated with the method of removing the lacrimal sac, but it should be very careful. Because once the lacrimal sac is removed, the tearing function of the lacrimal passage will no longer exist. In fact, this is a destructive operation, so it is not necessary to take such a surgical method. Treatment of diseases: dacryocystitis, chronic dacryocystitis Indication Corneal infection has occurred after chronic dacryocystitis, or the patient is old and frail, the lacrimal sac is atrophy, or the nasal cavity is not suitable for anastomosis with the lacrimal sac. Contraindications 1, acute dacryocystitis. 2, suitable for patients with dacryocystorhinostomy. Preoperative preparation 1. Check the nose and sinus first. One day before the operation, the lacrimal sac is washed, and the antibiotic eye drops are dripped into the conjunctival sac. 2, surface anesthesia of the punctum; in the lacrimal sac area, the top of the lacrimal sac and the upper nasolacrimal duct, 2 to 3 ml of 2% lidocaine for infiltration anesthesia; the lower nasal passage is filled with 1% dicaine and Cotton tablets with 0.5% ephedrine for 10 minutes. Surgical procedure 1. 3mm on the nasal side of the inner iliac crest, starting at 3mm on the medial malleolus plane, making a skin incision parallel to the anterior tear. The mouth is curved, about 15~20mm long, and reaches the full layer of the skin. 2. Insert the lacrimal sac expander and bluntly separate the skin and subcutaneous tissue, exposing the superficial fascia and the orbicularis oculi muscle. 3. Cut the superficial fascia to the full length of the skin incision. The aponeurosis of the orbicularis and tears (deep) fascia can be seen by separating the orbicularis muscles and pressing under the lacrimal sac. Cut the tear fascia before the lacrimal sac and cut off the internal hemorrhoids (or not cut the internal hemorrhoids). 4. Separate the tear fascia and the lacrimal sac wall to the sides with a periosteal separator. It is difficult to separate the temporal side, so it is preferred to separate the temporal side, and then reach the posterior lacrimal sac, up to the top of the lacrimal sac, down to the upper nasolacrimal duct. 5. The posterior side of the tear canal should be sneaked from the top and bottom. The lacrimal sac wall is separated from the lacrimal sac in the tear canal. If necessary, a lacrimal probe is inserted from the lower canal to help identify. 6. Open the tear fascia and separate the lacrimal sac from the bone wall of the lacrimal sac. When separating, close the bone wall up and down, up to the top of the lacrimal sac, down to the upper nasolacrimal duct, and then reach the tears. The nasal side of the lacrimal sac was separated from the lacrimal sac in all but the top and the nasolacrimal duct. 7. Use a vascular clamp to crimp the tear duct and cut it as far as possible from the lacrimal sac. Use a forceps to lift the lacrimal sac to cut the top of the lacrimal sac with scissors, and cut the lacrimal sac into the upper nasolacrimal duct. 8. Check whether the extracted lacrimal sac is intact. If the lacrimal sac remains in the lacrimal sac, apply a sharp spoon to the upper nasolacrimal duct. Burn the nasolacrimal duct, the tear duct end and the lacrimal sac cavity with a 3% iodine or silver nitrate cotton swab. 9. Probe into the nasolacrimal duct with probe No. 8 and go straight to the lower nasal passage. 10. Suture the internal hemorrhoid with 3-0 nylon thread, suture the tear fascia with 6-0 silk thread, and then suture the orbicularis muscle and skin with 3-0 silk thread. 11. Place a compression pillow in the teardrop removal section. Bandaged with a single eye bandage. complication Common complications are recurrence of dacryocystitis, and even inflammation around the lacrimal sac. If the general antibiotic treatment can not control inflammation for 3 to 5 days, sensitive antibiotics should be selected according to the culture.

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