目的 观测人泪道引流系统的Hasner瓣膜形态，提出形态学分型，为临床手术提供较为精确的参考依据。 方法 对45例成人Hasner瓣膜的存在率、形状、倾斜角、位置关系等进行解剖学测量，并进行K-mean1s聚类分析。 结果 本组标本中88%存在Hasner瓣膜，聚类为：A型：瓣膜的面积最大（平均皱襞切除术前后开口面积比S1/S2为0.533），覆盖鼻泪管开口的范围最广（平均膜定向范围角为166°）；B型：瓣膜开口的倾角最平（平均鼻泪管开口水平线倾斜角θ为47.6°），瓣膜最厚（平均皱襞厚度T为0.745 mm）；C型：瓣膜的面积最小（平均皱襞切除术前后开口面积比S1/S2为0.66），覆盖鼻泪管开口的范围最窄（平均膜定向范围角为149°），瓣膜最薄（平均皱襞厚度T为0.298 mm）。 结论 Hasner瓣膜可以分为A、B、C三型，本分型可为临床术式选择提供解剖依据：A型适用激光泪道成形术、鼻内镜Hasner瓣膜切除术等术式，B型适用泪囊鼻腔吻合术、泪小管切开术等旁路手术，C型适用泪道球囊扩张术等术式。
Abstract
Objective To observe the morphological parameters of the Hasner valve and to propose a morphological classification system that will serve as a reference for clinical surgical decision-making. Methods The presence rate, shape, inclination angle, coverage angle, thickness, opening area, and distance of the Hasner valve in 45 adult specimens were anatomically measured, followed by K-means cluster analysis. Results Among the 45 adult specimens, the Hasner valve was present in 88%. Clustering was identified three types: Type A: Largest valve area (mean pre-/post-resection opening area ratio [S1]/[S2] was 0.533) and widest coverage of the nasolacrimal duct orifice (mean membrane-directed coverage angle was 166°). Type B: Most horizontally oriented valve opening (mean nasolacrimal duct orifice inclination angle θ was 47.6°) and greatest valve thickness (mean plica thickness T was 0.745 mm). Type C: Smallest valve area (mean [S1]/[S2] was 0.66), narrowest coverage (mean membrane-directed coverage angle was 149°), and thinnest valve (mean plica thickness T was 0.298 mm). Conclusions The Hasner valve can be classified into Types A, B, and C. This new classification provides anatomical basis for selecting surgical approaches: Type A is suitable for laser lacrimal canaliculoplasty and endoscopic intranasal Hasner valve resection, type B is appropriate for bypass procedures such as dacryocystorhinostomy and canaliculotomy, type C is optimal for lacrimal balloon dacryoplasty.
关键词
泪道系统 /
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解剖学 /
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分类 /
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外科手术
Key words
Lacrimal apparatus /
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Anatomy /
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Classification /
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Surgical procedures
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参考文献
[1] Li Y, Wei M, Liu X, et al. Dacryoendoscopy-assisted incision of Hasner's valve under nasoendoscopy for membranous congenital nasolacrimal duct obstruction after probing failure: a retrospective study [J]. BMC Ophthalmol, 2021, 21(1): 182. DOI:10.1186/s12886-021-01948-w.
[2] Cnaan RB, Moosajee M, Heatley CJ, et al. Endoscopic endonasal retrieval of a nasolacrimal duct stone via the valve of Hasner in the inferior meatus [J]. Ophthalmic Plast Reconstr Surg, 2012, 28(2): e48-e50. DOI:10.1097/IOP.0b013e318220861f.
[3] 左国平, 柏根基, 王鹤鸣. 泪道的解剖及其在介入治疗中的意义 [J]. 南京医科大学学报, 1999, 19(6): 491-492.
Zuo GP, Bai GJ, Wang HM. Anatomy of lacrimal meatus and its significance in the interventional procedure [J]. Journal of Nanjing Medical University, 1999, 19(6): 491-492.
[4] 闫帅, 黄明玉, 祁存芳. 泪小管形态特点及其临床应用解剖研究 [J]. 中国临床解剖学杂志, 2017, 35(6): 601-606. DOI:10.13418/j.issn.1001-165x.2017.06.001
Yan S, Huang MY, Qi CF. The research of morphological features and clinical applied anatomy of lacrimal canaliculis [J]. Chin J Clin Anat, 2017, 35(6): 601-606. DOI:10.13418/j.issn.1001-165x.2017.06.001
[5] 张速勤, 贾沛靓, 唐海红, 等. 泪囊鼻内解剖研究及临床应用 [J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(7): 506-509.
Zhang SQ, Jia PL, Tang HH, et al. Endonasal anatomy of lacrimal sac and its clinical significance in dacryocystorhinostomy[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2006, 41(7): 506-509.
[6] Das S, Ali M J, Bansal S, et al. Lacrimal Sac Pneumatocele Following Blunt Nasal Trauma [J]. Ophthalmic Plast Reconstr Surg, 2017, 33(6): e150-e151. DOI:10.1097/IOP.0000000000000918.
[7] Imschoot JYC, Bauters W, Van Zele T, et al. Congenital bilateral dacryocystocoele: A neonatal emergency [J]. Int J Surg Case Rep, 2021, 80: 105603. DOI:10.1016/j.ijscr.2021.01.097.
[8] Hashemi SM, Berjis N, Eshaghian A, et al. Applied Endoscopic Anatomical Evaluation of the Lacrimal Sac [J]. Iran J Otorhinolaryngol, 2015, 27(80): 213-217.
[9] Orhan M, Govsa F, Saylam C. Anatomical details used in the surgical reconstruction of the lacrimal canaliculus: cadaveric study [J]. Surg Radiol Anat, 2009, 31(10): 745-753. DOI: 10.1007/s00276-009-0515-x.
[10]Orhan M, Ikiz ZA, Saylam CY. Anatomical features of the opening of the nasolacrimal duct and the lacrimal fold (Hasner's valve) for intranasal surgery: a cadaveric study [J]. Clin Anat, 2009, 22(8): 925-931. DOI:10.1002/ca.20866.
[11]Kim YH, Park MG, Kim GC, et al. Topography of the nasolacrimal duct on the lateral nasal wall in Koreans [J]. Surg Radiol Anat, 2012, 34(3): 249-255. DOI:10.1007/s00276-011-0858-y.
[12]Ali MJ, Schicht M, Paulsen F. Morphology and morphometry of lacrimal drainage system in relation to bony landmarks in Caucasian adults: a cadaveric study [J]. Int Ophthalmol, 2018, 38(6): 2463-2469. DOI:10.1007/s10792-017-0753-6.
[13]Orhan M, Saylam CY, Midilli R. Intranasal localization of the lacrimal sac [J]. Arch Otolaryngol Head Neck Surg, 2009, 135(8): 764-770. DOI:10.1001/archoto.2009.94.
[14]Tatlisumak E, Aslan A, Comert A, et al. Surgical anatomy of the nasolacrimal duct on the lateral nasal wall as revealed by serial dissections [J]. Anat Sci Int, 2010, 85(1): 8-12. DOI:10.1007/s12565-009-0044-z.
[15]Takahashi Y, Kakizaki H, Nakano T, et al. Anatomy of the vertical lacrimal canaliculus and lacrimal punctum: a macroscopic study [J]. Ophthalmic Plast Reconstr Surg, 2011, 27(5): 384-386. DOI:10.1097/IOP.0b013e318219a54b.
[16]Zoumalan CI, Joseph JM, Lelli GJ, JR., et al. Evaluation of the canalicular entrance into the lacrimal sac: an anatomical study [J]. Ophthalmic Plast Reconstr Surg, 2011, 27(4): 298-303. DOI:10.1097/IOP.0b013e31820d1f7b.
[17]Park J, Takahashi Y, Nakano T, et al. The orientation of the lacrimal fossa to the bony nasolacrimal canal: an anatomical study [J]. Ophthalmic Plast Reconstr Surg, 2012, 28(6): 463-466. DOI: 10.1097/IOP.0b013e31826463d9.
[18]Takahashi Y, Nakamura Y, Nakano T, et al. Horizontal orientation of the bony lacrimal passage: an anatomical study [J]. Ophthalmic Plast Reconstr Surg, 2013, 29(2): 128-130. DOI: 10.1097/IOP.0b013e31827f59f5.
基金
中山大学2024年大学生创新创业训练（20242453）；中山大学中山医学院本科教学质量与教学改革工程类项目
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