放射核素对鼻腔泪囊吻合术的评价

目的运用99mTcO4-放射性核素显像技术对鼻腔泪囊吻合术进行评价。方法用放射性核素显像技术对37例行鼻腔泪囊吻合术的慢性泪囊炎病人在手术前后进行检查,同时测定泪囊的横径。结果37例行手术的病人术后有32例显像通畅与随访结果相符;5例有并发症的仍不通畅。结纶核素显像技术能确切地反映鼻泪道状况,是一种切实可用的随访评价指标。女性患者泪囊横径随年龄增大而缩小,不同年龄组间有显著性差异。     

Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy

Objectives and Study Design: The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery (FESS) technique have awakened interest in an endonasal endoscopic dacryocystorhinostomy (EESC-DCR) in treating nasolacrimal obstruction. This prospective, randomized study compares EESC-DCR with traditional external dacryocystorhinostomy (EXT-DCR) for their success rates, surgical duration, and postoperative symptoms. Patients and Methods: Sixty-four cases in 60 patients with primary acquired nasolacrimal sac or duct obstruction were divided into two subgroups by symptoms (simple epiphora/ chronic dacryocystitis). These patients were randomized within both subgroups into two operation groups. Altogether 32 EESC-DCRs and 32 EXT-DCRs were performed. The final follow-up visit was at 1 year. The patency of the lacrimal passage was investigated by irrigation and patients were questioned about their symptoms. Results: The success rate at 1 year after surgery was 75% for EESC-DCR and 91% for EXT-DCR after primary surgery. The difference was not statistically significant (P = .18). The success rate after secondary surgery with a follow-up time of 1 year was 97% in both study groups. The average duration for EESC-DCR was 38 minutes, and 78 minutes for EXT-DCR, (P < .001). Conclusions: EXT-DCR, when compared with EESC-DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.     

两种鼻黏膜切口在鼻内镜下鼻腔泪囊吻合术中的应用

目的：比较两种鼻黏膜切口在鼻内镜下鼻腔泪囊吻合术中出血情况和术后治疗效果。

方法：回顾性研究。收集2016-06/2018-05在我院眼科确诊为慢性泪囊炎并接受鼻内镜下鼻腔泪囊吻合手术治疗的患者63例66眼。根据鼻黏膜瓣基底部位的不同分组,A组以中鼻甲腋为基底的鼻腔黏膜切口行泪囊鼻腔吻合术,B组以上颌骨线为基底的鼻腔黏膜切口行泪囊鼻腔吻合术。随访至术后6mo,比较两组患者术中出血和术后疗效。

结果：两组患者术中出血情况有差异(χ²=11.803,P<0.05),术后有效率比较无差异(82% vs 73%,P>0.05)。

结论：以中鼻甲腋为基底部的鼻腔黏膜切口,术中并发出血较多; 而以上颌骨线为基底的鼻腔黏膜切口,术中出血较少。两组患者术后疗效无差异。     

鼻腔泪囊吻合术中填充美乐胶治疗小泪囊泪囊炎

目的：观察美乐胶(MeroGel)在经鼻内镜下鼻腔泪囊吻合术(EN-DCR)治疗小泪囊泪囊炎的疗效。

方法：选取2014-06/2018-12我院收治的小泪囊泪囊炎患者185例185眼,鼻腔泪囊吻合术(DCR)中分别使用MeroGel、明胶海绵、膨胀海绵和凡士林纱条,观察各组患者术后并发症和造口恢复情况。

结果：使用MeroGel的患者术后眼角和鼻腔渗血少,后期复查无痛苦,造口恢复情况较其他各组更佳(P<0.05)。

结论：MeroGel减少了DCR术后渗血,同时其可降解性有助于EN-DCR术后造口黏膜上皮化,尤其在小泪囊泪囊炎术后,能抑制造口粘连及周边肉芽组织增生,大大提高小泪囊泪囊炎的成功率,相比于其他填塞材料,使用MeroGel后并发症更少,患者更舒适。     

Endoscopic dacryocystorhinostomy following radioactive iodine thyroid ablation

This article evaluates the efficacy of endoscopic dacryocystorhinostomy (eDCR) for nasolacrimal duct obstruction (NLDO) in patients exposed to radioactive iodine (RAI) for treatment of thyroid carcinoma. Retrospective chart review of 7 eDCR procedures was performed on 6 patients, aged 18 or older, with prior RAI treatment, who underwent eDCR between January 1, 2008 and December 31, 2013 for treatment of epiphora due to NLDO. Average time to tube removal was 159 days, and average follow-up was 341 days. One patient noted complete epiphora relief at the time of their final visit. Partial symptom relief was noted by 3 patients, and recurrent epiphora was noted by 2 patients. In complex patients with RAI-associated NLDO, eDCR may be a reasonable option for relief of epiphora. Appropriate counseling, including the risks of incomplete symptom relief and need for additional surgery, should be discussed pre-operatively with these patients.     

鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的临床研究

目的：：观察鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的疗效并探讨手术操作技巧。方法：回顾分析鼻内镜下鼻腔泪囊造口术治疗的慢性泪囊炎患者140例169眼,对随访6~12 mo的临床资料进行总结和分析,评价治疗效果并探讨鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术技巧。结果：本组痊愈155眼(91.7％),好转3眼(1.8％),无效11眼(6.5％),总有效率93.5％,与传统泪囊鼻腔吻合术组术后疗效比较,无显著性差异(χ2=3.743,P>0.05)。结论：鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎有较好的治疗效果。泪囊的定位及大小、造口位置及大小、造口黏膜瓣的处理、鼻部疾病的处理等操作技巧、术后随访及处理和患者体质均可能影响手术疗效。     

经泪囊鼻腔改良吻合术治疗慢性泪囊炎42例

目的：观察经泪囊鼻腔改良吻合术治疗慢性泪囊炎疗效。方法：回顾性分析2010年2月至2013年7月收治42例慢性泪囊炎患者,采用经泪囊鼻腔改良吻合术治疗,术后随访1年,总结手术治疗效果。结果：42例患者中,达到治愈效果的39例（92．9％）、好转2例（4．8％）,未愈1例（2．4％）,总有效率97．6％。结论：经泪囊鼻腔改良吻合术治疗慢性泪囊炎,手术成功率高,并发症少,适合于经济欠发达地区临床推广应用。     

Surgical treatment of obstruction of the nasolacrimal ducts in patients with anatomical endonasal variants

The presence of anatomical endonasal variants (concha bullosa, nasal septal deviation, or hypertrophic turbinates) may cause more complications in patients with epiphora who have external dacryocystorhinostomy (DCR). The purpose of this study was to assess the results of surgical placement of a stent in 28 patients. They were randomised into two groups and had either DCR or placement of a Song's polyurethane stent. They were followed up for 18 months. Twenty-six patients had a good result. The success rate was 13/14 for those who had DCR and 13/14 for those who had a stent. Operating time was significantly less for placing a stent (mean (SD) 15 (2) minutes) compared with 40 (3) minutes for DCR (p<0.01). Placement of a polyurethane stent is an effective and short procedure for nasolacrimal obstruction, which is suitable for patients with unusual intranasal conditions.     

内窥镜下改良球形头硅胶管插管与泪囊鼻腔吻合术治疗鼻泪管阻塞的比较

目的:比较内窥镜下球形头硅胶管插管(SHSI)与泪囊鼻腔吻合术(En-DCR)治疗鼻泪管阻塞(NLDO)的疗效与经济效益。方法:将43例50眼NLDO患者随机分为SHSI组(21例25眼)和En-DCR组(22例25眼),比较两组患者术中出血量、单眼手术时间、手术不适及住院时间,随访至术后12mo,根据末次随访时溢泪与泪道灌洗情况评估临床疗效,并采用成本-效果比(C/E)进行经济效益评估。结果:SHSI组患者术中出血量与手术不适视觉模拟评分显著低于En-DCR组(4.96±1.989mL vs 27.60±14.950mL,2.84±0.64分vs 4.88±0.84分),单眼手术时间与住院时间显著短于En-DCR组(13.40±6.007min vs 59.64±12.786min,0.50±0.010h vs 137.280±23.085h)(均P<0.001)。末次随访时,两组患者临床有效率无差异(88%vs 96%,P>0.05),但SHSI组患者C/E(13.57)远小于En-DCR(121.50)。结论:内窥镜下SHSI与En-DCR均为NLDO的有效手术治疗方法,但SHSI手术难度相对更低且具有明显的成本效益优势。     

经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的影响因素分析

目的：探讨影响经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的相关因素。

方法：回顾性分析2015-07/2019-04在我院行经鼻内窥镜下鼻腔泪囊吻合手术治疗的泪囊炎患者380例413眼的临床资料,术后至少随访6mo,根据泪囊、鼻腔、吻合口、泪道功能恢复情况评定临床疗效,筛选影响手术效果的相关因素。

结果：术后6mo时,未愈患者27例27眼(6.5%),治愈患者353例386眼(93.5%)。单因素分析结果表明,患者鼻中隔偏曲程度、小泪囊、反复泪道探通/泪道激光/泪道置管、复发性泪囊炎、术后定期复诊和术者开展手术时间均对手术疗效存在影响。Logistic回归分析结果显示,患者鼻中隔偏曲程度、小泪囊、术后是否定期复诊是泪囊炎患者行经鼻内窥镜下鼻腔泪囊吻合术临床疗效的危险因素。

结论：经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效确切,术后治愈率较高。患者鼻中隔偏曲的严重程度、小泪囊和术后是否定期复诊是影响手术疗效的危险因素。术者娴熟的手术技术和规范的手术后处理及患者良好的医嘱依从性是手术成功的关键。