内镜下泪囊鼻腔吻合术与经典开放术式的疗效对比

目的 比较经鼻内镜下泪囊鼻腔吻合术与经面部切口的经典泪囊鼻腔吻合术治疗慢性泪囊炎和鼻泪管梗阻的疗效。方法 回顾分析2010年1月至2013年8月收治的46例、53眼慢性泪囊炎和鼻泪管梗阻患者手术治疗的效果,其中行经典泪囊鼻腔吻合术22例（26眼）,鼻内镜下泪囊鼻腔吻合术24例（27眼）。结果 经典泪囊鼻腔吻合术治愈25眼,好转1眼,无效0眼,治愈率96.2%,有效率100%;鼻内镜下泪囊鼻腔吻合术治愈25眼,好转2眼,无效0眼,治愈率92.6%,有效率100%。采用多个样本的秩和检验,两组比较差异无统计学意义（P>0. 05）。结论 经鼻内镜下泪囊鼻腔吻合术与经典泪囊鼻腔吻合术治疗慢性泪囊炎和鼻泪管梗阻的疗效接近,但鼻内镜下泪囊鼻腔吻合术无需面部皮肤切口,创伤小,疗效确切,出血少,值得推广。     

改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎

目的:探讨改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎的手术方法及其疗效。方法:通过对造孔、泪囊黏膜瓣的切开及固定方式等的改良处理,在鼻内镜下完成泪囊鼻腔造孔术治疗慢性泪囊炎22例(23眼)。结果:术后随访6～10个月,平均8个月。22例(23眼)中,21例(22眼)治愈,症状完全消失,泪道冲洗畅通,内镜检查造孔通畅;1例(1眼)症状改善不明显。总有效率95.7%(22/23)。所有患者未出现严重并发症。结论:改良鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎明显提高了手术成功率,值得临床推广。     

经鼻内镜鼻腔泪囊开放术治疗慢性泪囊炎

目的 分析经鼻内镜鼻腔泪囊开放术治疗慢性泪囊炎的手术方式及治疗效果。方法 收治慢性泪囊炎患者30例,均行鼻内镜下泪囊开放术,术后行泪道冲洗,随访6~12个月,观察手术疗效。结果 手术均顺利进行,30例术中、术后均无并发症发生,治愈28例(93.3%),好转2例(6.6%)。结论 鼻内镜下鼻腔泪囊开放术视野清晰、无面部瘢痕,治疗慢性泪囊炎效果良好,符合外科手术微创和美容的要求。     

External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

To compare external and endoscopic dacryocystorhinostomy outcomes in patients with chronic dacryocystitis, a total of 103 patients with the complaint of epiphora and diagnosed as chronic dacryocystitis were included in the study. We performed external dacryocystorhinostomy on 55 patients under local anesthesia and endoscopic dacryocystorhinostomy on 48 patients under general anesthesia by means of drill and placed silicon stents to all the patients. The patients were examined endoscopically, at postoperative intervals of 1 week, first month, third month, sixth month and the first year. The patency of the tubes and nasolacrimal ducts were evaluated by irrigation and complaints of the patients were noted. Silicon stents were harvested at the sixth week postoperatively. Outcomes were classified as successful when epiphora diminished, no recurrent infection was noted and minimal or no reflux from the canaliculis during or after lacrimal irrigation was seen. A prospective endoscopic surgery group was compared to a prospective control group (external dacryocystorhinostomy). Full success was achieved in 69.9% of the patients with external dacryocystorhinostomy group whereas the full success rate of endoscopic dacryocystorhinostomy was 89.7%. Recently popularized endoscopic dacryocystorhinostomy is a safe and reliable procedure with high success rates.     

5-氟尿嘧啶与丝裂霉素C在改良外路泪囊鼻腔吻合术中的应用疗效比较

<正>慢性泪囊炎是最常见的泪囊病变类型,发病原因为鼻泪管下端阻塞或狭窄,导致分泌物滞留于泪囊内,继而伴发细菌感染引起。主要临床症状为流泪、溢脓[1]。随着医疗科技水平的提高,手术方式呈多样化,改良的外路鼻腔泪囊吻合术成功率达90%以上,作为一种经典术式,目前仍应用广泛[2-3],而抗代谢药物的应用明显提高了手术的成功率[4]。我们在改良外路鼻腔泪囊吻合术中应用5-氟尿嘧啶(5-fluorouracil,5-FU)和丝裂霉素C(mitomycin C,MMC)预防术后造骨孔远期瘢痕粘连,现报告如下。     

Otologic T-tube in endonasal dacryocystorhinostomy: a new approach

Conclusion. Otologic T-tubes had a success rate of 73% if implanted during endoscopic dacryocystorhinostomy (DCR). We suggest that they can be used successfully in endoscopic DCR, and are promising as an alternative to silicone stent intubations. Objective. To evaluate the efficacy of endoscopic DCR using otologic T-tube. Materials and methods. Twenty patients (22 eyes) with nasolacrimal duct obstruction underwent endoscopic DCR. After creating an aperture in the medial wall of the lacrimal sac, the otologic T-tube (1.15 mm diameter, Invotec, Jacksonville, FL, USA) was inserted into the sac transnasally. The T-tube was left in the lacrimal sac for between 3 and 6 months. The patients were followed up for between 6 and 24 months (mean 12.4 months). The improvement in patients’ epiphora complaint was grouped as very good, good, or no change. Results. Eleven eyes (50%) proved to be ‘very good’, whereas five eyes (23%) were good, and six eyes (27%) had no change. Of six eyes that were reported to have no change after the operation, three experienced spontaneous tube loss in the early period, one eye was a recurrent case, and the other two were primary cases.     

A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomy

We retrospectively reviewed all primary external dacryocystorhinostomies (DCRs) and endonasal KTP laser DCRs performed for epiphora as a result of nasolacrimal duct obstruction in our unit between 1993 and 2000. Forty-nine patients underwent an external approach and 76 endonasal laser procedures were performed. The success rate of the external group was 94% with a mean follow-up of 9 months. In contrast, the endonasal group's success rate was 64% with a mean follow-up of 12 months. This difference reached statistical significance (P = 0.0002). However, when including revision procedures, the success rate in the endonasal group increased from 64% to 82%. The success rate in the endonasal group improved from 50% in the first 38 cases to 79% in the last 38 cases (P = 0.0084), thereby demonstrating a learning curve. Our study confirms external DCR as the 'gold standard' for a successful outcome. However, the endonasal technique has significant advantages, including being a quicker procedure with less morbidity, no cutaneous scar, and being more amenable to a bilateral procedure, daycase surgery and local anaesthetic. We are persisting with the endonasal technique because of its advantages but have moved towards more 'cold steel' techniques in an effort to improve results and emulate other series. In conclusion, for nasolacrimal duct obstruction, the endonasal technique is our approach of choice, with revision surgery if necessary, and the external technique is held in reserve.     

Endoscopic dacryocystorhinostomy vs KTP 532 laser-assisted endoscopic dacryocystorhinostomy

Objectives  Advances in endoscopy and lasers have improved surgical management of chronic nasolacrimal duct obstruction. This is a preliminary comparison between standard and laser assisted endoscopic dacryocystorhinostomy (DCR). Study Design  Combined retrospective and prospective study. Setting  Tertiary referral hospital. Patients and Methods  Thirty-eight cases of chronic nasolacrimal duct obstruction underwent endoscopic DCR (26 standard and 12, laser-assisted) and were assessed at 3 and at 6 months postoperatively by nasal endoscopy. Results  Three months postoperatively (n=38), total relief of epiphora among the nonlaser group was 80.76 vs 75% in the laser group (P=0.982). At 6 months (n=19), the laser group had recorded 100% symptomatic relief compared to 85.71% in the nonlaser group (P=0.964). The laser group suffered fewer complications (33.33 vs 46.15% for nonlaser group). Conclusion  Lasers show promise in long-term management of duct obstruction and are associated with fewer complications. A larger study is required before and generalization is made.     

Pediatric endonasal dacryocystorhinostomy: a report of 34 cases

OBJECTIVES: To present experience with the endoscopic dacryocystorhinostomies (EDCR) at the pediatric age. STUDY DESIGN: Case series, clinical study. METHODS: The operative and postoperative data have been collected in 34 pediatric EDCRs (mean age 4.5 years; range 4 months to 13 years). The total of 34 primary and 5 revision procedures have been performed by the same surgeon using a standardized surgical technique. The follow-up evaluations include symptom evaluations and the endoscopic assessment of the newly created ostium with fluorescein testing. RESULTS: The 28 of 34 primary EDCRs (82.3%) were patent after a mean follow-up of 12 to 36 months: 24 of 27 (88.9%) procedures with subsaccal obstructions, 3 of 5 (60.0%) with combined subsaccal and suprasaccal obstructions, and 1 of 2 (50.0%) with suprasaccal obstructions. Intubation was used in 30 primary EDCRs. We found no differences in the success rate between the group with operative intranasal debridement and the group without it in the follow-up period. EDCRs failed in six patients, five of whom were revised endoscopically with success. CONCLUSIONS: EDCRs in children appear to provide a safe and successful procedure with the success rate comparable with those achieved with external DCRs and those in adults.     

A comparison of endonasal with external dacryocystorhinostomy in revision cases

The objective is to compare the success rates of revision endonasal dacryocystorhinostomy (END-DCR) with revision external dacryocystorhinostomy (EXT-DCR). The present retrospective study was conducted between January 2002 and July 2009. Seventy-four consecutive patients (17 males, 57 females) who had epiphora or recurrent dacryocystitis after a previous failed EXT-DCR procedure were enrolled in the study. The END-DCR group consisted of 43 patients (10 males, 33 females) who underwent 44 END-DCRs, whereas the EXT-DCR group included 31 patients (7 males, 24 females) who underwent 31 dacryocystorhinostomies (DCRs). Successful DCR was defined as relief of symptoms as demonstrated by saline irrigation at the last post-operative visit. Further nasal surgery was performed in 18 (40.9%) eyes in the END-DCR group. The average follow-up time for the END-DCR and EXT-DCR groups was 11 and 9?months, respectively. The success rate was 77.4% (24/31 DCRs) in the END-DCR group, and 84.1% (37/44 DCRs) in the EXT-DCR group. There was no significant difference between the groups regarding overall success (p?=?0.465). END-DCR is as safe and efficient technique as external approach with low complication rates in revision cases. END-DCR yields good esthetic and functional results and has a success rate similar to that of the external approach.     

鼻内镜下泪囊鼻腔造孔术造孔的处理

目的:探讨更好地处理鼻内镜下泪囊鼻腔造孔术造孔的方法。方法:102例(109眼)慢性泪囊炎患者于鼻内镜下行泪囊鼻腔造孔术,术中用银夹固定造孔,术后给予综合治疗,并随访3～73个月。结果:治愈99眼(91.0%),好转5眼(4.5%),有效率95.5%。结论:泪囊鼻腔造孔术用银夹固定造孔,术后辅以综合治疗,可有效防止造孔的狭窄、闭锁。     

Revision dacryocystorhinostomy: a comparison of endoscopic and external techniques

BACKGROUND: Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the ability of the surgeon to achieve good nasal and lacrimal mucosa apposition. This study evaluates the comparative success rates of the external and endoscopic techniques for revision DCR. METHODS: Seventeen consecutive revision endoscopic DCRs (average age, 60.9 years) and 13 revision external DCRs (average age, 65.1 years) performed from January 1999 to December 2000 performed by separate surgeons were entered into the study. Patients with functional nasolacrimal and canalicular obstruction were excluded. The average follow-up was 11.1 months for the endoscopic DCR group and 10 months for the external DCR group. RESULTS: A successful DCR required complete relief of symptoms and an endoscopically determined anatomic patency of the nasolacrimal system. Revision endoscopic DCR surgery was successful in 76.5% of cases (13 of 17 cases) and external DCR surgery was successful in 84.6% (11 of 13 cases). This difference was not statistically significant. (p = 0.64, Fisher exact test with a two-tailed probability). CONCLUSION: Revision endoscopic DCR has a success rate of 76.5%, which compares favorably with that of the revision external DCR (84.6%).     

鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术探讨

目的 探讨经鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术方式、技巧及临床疗效。方法 采用鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎28例(30眼),术后在鼻内镜下行常规泪道冲洗及鼻腔清理换药。结果 所有病例随访6个月,治愈率93.33%,总有效率100% 。结论 经鼻内镜下泪囊鼻腔吻合术是治疗慢性泪囊炎的理想方法,具有创伤性小、治愈率高、不影响美容的特点。