胡晓勋 刘丹 黄志群

[摘要] 目的 研究鼻腔外側壁解剖标志与泪囊窝关系。 方法 对我院PACS系统中2019年1月至2020年12月100例慢性泪囊炎患者鼻窦薄层轴位CT影像图片（排除鼻息肉、鼻窦肿瘤、鼻外伤）进行回顾性分析。采用GE256排螺旋CT以听眦线为扫描基线对鼻窦进行螺旋扫描。利用CT测距功能键在横断面测量相关指标，统计分析患侧组和健侧组泪囊窝的前后嵴距离、上颌骨额突厚度、泪囊窝上颌骨类型，并分析鼻腔外侧壁泪囊膜投影和鼻腔内结构的相对毗邻关系、中鼻甲前端鼻腔外侧壁附着处和泪囊窝鼻腔外侧壁投影关系、纸样板沿长线和泪囊窝的关系。 结果 患侧中鼻甲前端鼻腔外侧壁附着点处最低点水平面的泪囊窝的上颌骨额突厚度小于健侧（P<0.05）。纸样板沿长线和泪囊窝的关系为穿过型、外侧型在患侧组占比为90.00%（90/100）、10.00%（10/100），健侧组为85.00%（85/100）、15.00%（15/100），差异无统计学意义（P>0.05）。 结论 CT影像学能够对鼻腔中泪囊的投影进行准确定位，帮助临床将合适的鼻黏膜切口位置选取出来，对手术难易程度进行判定，从而促进并发症发生的减少。

[关键词] CT;影像学;泪囊窝;鼻腔外侧壁解剖标志;关系

[中图分类号] R322          [文献标识码] B          [文章编号] 1673-9701（2021）35-0077-04

Relationship between anatomical landmarks of the lateral wall of the nasal cavity and the lacrimal fossa

HU Xiaoxun   LIU Dan   HUANG Zhiqun

Department of Otolaryngology Head and Neck Surgery， Jiujiang University Affiliated Hospital， Jiujiang   332000， China

[Abstract] Objective To study the relationship between anatomical landmarks of the lateral wall of the nasal cavity and the lacrimal fossa. Methods The axial CT images of the thin layer of nasal sinuses of 100 patients with chronic dacryocystitis （excluding nasal polyps， sinus tumors， and nasal trauma） in our Picture Archiving and Communications System （PACS） from January 2019 to December 2020 ware retrospectively analyzed. Spiral scans of the sinuses were performed using GE 256-row spiral CT with the orbitomeatal base line as the scan baseline. The relevant indexes were measured in the cross-sectional plane using the CT distance measurement function key. The distance between the anterior and posterior crista of the lacrimal fossa on the affected and the healthy side， the thickness of the processus frontalis maxillaeta， the type of maxillary bone of the lacrimal fossa were statistically analyzed， and the corresponding relationship between the projection of lacrimal sac membrane on the lateral wall of the nasal cavity and the structures of the inner nasal cavity， the relationship between the attachment of the lateral wall of the nasal cavity at the anterior middle turbinate and the projection of the lateral wall of the nasal cavity at the lacrimal fossa， and the relationship between the paper sample plate extension line and the lacrimal fossa were analyzed. Results The thickness of the processus frontalis maxillaeta of the lacrimal fossa at the level of the lowest point at the attachment point of the lateral nasal wall of the anterior middle turbinate on the affected side was thinner than that on the healthy side （P<0.05）. The relationship between the paper pattern along the long line and the lacrimal fossa is that the penetration type and the lateral type account for 90.00% （90/100） and 10.00% （10/100） in the affected side group， and 85.00% （85/100） in the uninfected side group）， 15.00% （15/100）， the difference was not statistically significant （P>0.05）. Conclusion CT imaging can accurately localize the projection of the lacrimal in the nasal cavity， and help clinicians to select the appropriate nasal mucosal incision site and determine the difficulty degree of surgery， thus reducing the incidence of complications.

[Key words] CT; Imaging; Lacrimal fossa; Anatomical landmarks of the lateral wall of the nasal cavity; Relationship

慢性泪囊炎是鼻眼相关外科最常见疾病，溢泪症状严重影响病人生活质量，且存在致盲、屈光不正、急性眶周感染等风险[1]。随着鼻内镜外科的发展，鼻内镜下泪囊鼻腔吻合术成为治疗慢性泪囊炎的主要方法，有逐步替代经内眦部皮肤入路的泪囊鼻腔吻合术的趋势，具有微创、面部无瘢痕、泪囊周围组织损伤少、对泪泵功能影响小、创口愈合快、可再次修正手术，同期可对阻塞泪道的鼻腔鼻窦疾病进行处理等诸多优点，被越来越多的鼻科和眼科医师所掌握[2]。……