Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy

One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.     

丝裂霉素C在鼻内镜下泪囊鼻腔吻合术中的应用分析

目的：探讨在经鼻内镜泪囊鼻腔吻合术中应用丝裂霉素C治疗慢性泪囊炎的疗效。方法：收集57例63眼慢性泪囊炎患者,在经鼻内镜泪囊鼻腔吻合术中应用丝裂霉素C,观察其临床疗效。结果：术后随访6mo以上,治愈54例59眼（95%）;好转3例4眼（5%）,总有效率100%。结论：在经鼻内镜泪囊鼻腔吻合术中局部应用丝裂霉素C治疗慢性泪囊炎,治愈率高,面部不留瘢痕,出血少,泪囊定位准确,同时丝裂霉素C能有效抑制创面肉芽组织生长和纤维瘢痕形成,减少术后吻合口闭锁,提高手术成功率,是一种安全有效的治疗方式。     

丝裂霉素C在经鼻内镜泪囊鼻腔吻合术中的应用

目的:探讨在经鼻内窥镜泪囊鼻腔吻合术中应用丝裂霉素C治疗慢性泪囊炎的临床疗效。方法:将65例慢性泪囊炎患者分为治疗组和对照组;治疗组在经鼻内窥镜泪囊鼻腔吻合术中局部应用0.4mg/mL丝裂霉素C,对照组行传统泪囊鼻腔吻合术;术后随访12mo,观察患者泪道通畅情况,鼻内窥镜下测量造瘘口面积,检查鼻腔结构恢复情况。结果:治疗组35例39眼,治愈38眼,治愈率97%;对照组30例34眼,治愈26眼,治愈率76%,两组之间的差异有统计学意义(P<0.05)。结论:在经鼻内窥镜泪囊鼻腔吻合术中局部应用丝裂霉素C治疗慢性泪囊炎,组织损伤小、面部不留瘢痕,能有效减少术后吻合口闭锁,提高手术成功率,可作为一种简便、安全有效的治疗方式。     

鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C治疗鼻泪道阻塞

目的:探讨鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C(MMC)治疗鼻泪道阻塞的疗效和安全性。方法:选择32例38眼鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)患者,鼻内镜下鼻丘处制成骨孔,切开泪囊并充分翻转泪囊前后瓣,0.1g/L MMC棉球于泪囊吻合口保留48h后取出。结果:术后7d;3,6mo行鼻内镜检查并冲洗泪道。术后7d,治愈34眼,好转3眼,无效1眼,治疗好转率97.4%;术后3mo,治愈32眼,好转4眼,无效2眼,治愈好转率94.7%;术后6mo,治愈32眼,好转4眼,无效2眼,治疗好转率94.7%。所有病例,均未发生鼻出血和眼眶内并发症等术后并发症。结论:鼻内镜下泪囊鼻腔吻合术联合MMC治疗鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)是一种安全有效的治疗方法。     

丝裂霉素C应用于鼻内镜下鼻腔泪囊造孔术的临床观察

目的：：观察注射用丝裂霉素C ( MMC )应用于鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎的临床疗效及安全性。方法：选取我院2012-07/2015-06确诊为慢性泪囊炎的患者297例328眼,其中单眼266例,双眼31例,随机分为治疗组166例166眼,对照组162例162眼(如为双眼患病者,1眼纳入治疗组,1眼纳入对照组),均采用鼻内镜下鼻腔泪囊造孔联合鼻泪管引流支架置入的手术方式,治疗组局部应用0.2mg/mL 丝裂霉素 C,对照组则不使用;术后随访3~36mo,观察患者临床疗效及安全性。结果：治疗组166眼,治愈121眼,好转37眼,无效8眼,总有效率95.18％;对照组162眼,治愈103眼,好转36眼,无效23眼,总有效率85.80％;两组之间的差异有统计学意义(P<0.05)。结论：丝裂霉素C应用于鼻内镜下鼻腔泪囊造孔术治疗慢性泪囊炎,组织损伤小,能有效减少术后造孔处瘢痕粘连及肉芽组织增生,提高手术成功率,是一种简便、安全、有效的治疗方式。     

Results of endoscopic endonasal non-laser dacryocystorhinostomy

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.     

聚四氟乙烯在泪囊炎鼻腔内窥镜手术中的应用

目的:使用聚四氟乙烯膜提高泪囊炎鼻腔内窥镜手术的成功率。方法:在常规鼻腔内窥镜泪囊炎手术的基础上使用聚四氟乙烯膜做造孔支撑物,不用银夹将泪囊和鼻黏膜夹持。结果:本组56例56眼,手术后1～3mo拔膜,随访1～6mo,泪溢、溢脓消失,泪小点无撕裂。结论:聚四氟乙烯膜做为泪囊炎手术后造孔支撑物有良好的组织相容性,其直径可控,留膜期间患者舒适,手术成功率高,易于普及。     

经鼻内窥镜泪囊鼻腔吻合术的研究进展

鼻泪管阻塞的手术方法主要包括经皮肤切口泪囊鼻腔吻合术和经鼻内窥镜泪囊鼻腔吻合术,其中经鼻内窥镜泪囊鼻腔吻合术具有外科创伤小,手术时间和住院时间短,术后痛苦小、恢复快、无颜面部瘢痕,保护“泪液泵”生理功能等优点。随着手术设备和鼻内镜技术的改进,经鼻内窥镜泪囊鼻腔吻合术以其较高的手术安全性和成功率,已成为鼻泪管阻塞性疾病的重要治疗手段,本文主要就其手术适应证、辅助技术应用、手术效果评价以及导致手术失败相关因素等方面的研究进展作一综述。     

鼻内镜下泪囊鼻腔吻合术联合应用丝裂霉素C

目的探讨鼻内镜下泪囊鼻腔吻合术中应用丝裂霉素C治疗慢性泪囊炎的临床效果。方法150例（158只眼）慢性泪囊炎随机分为两组,在施行鼻内窥镜下泪囊鼻腔吻合术中联合应用丝裂霉素C置于吻合口骨窗处（治疗组）75例80只眼;及单纯行鼻内窥镜下泪囊鼻腔吻合术（对照组）75例（78只眼）。随访3—12个月。结果术后6个月时治疗组的治愈率及有效率分别为95．00％、98．75％,对照组的治愈率及有效率分别为75．64％、93．59％。治疗组的治愈率高于对照组（χ^2=11．90,P〈0．05）。结论鼻内窥镜下泪囊鼻腔吻合术中联合应用丝裂霉素C有利于预防吻合口瘢痕粘连及提高远期疗效,是一种微创有效的方法。     

Intraoperative mitomycin C in dacryocystorhinostomy

PURPOSE: To assess the efficacy of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (EXT-DCR). METHODS: Forty-six cases (50 lacrimal drainage systems [LDS]) with nasolacrimal duct obstruction were randomized into three groups. In the control group, a standard EXT-DCR procedure was performed. In the two MMC groups, a piece of cotton soaked with 0.2 mg/ml MMC (group 1) or 0.5 mg/ml MMC (group 2) was applied to the nasal mucosa and the mucosa of the lacrimal sac in the osteotomy site for 5 minutes. RESULTS: The dacryocystorhinostomy in all patients was patent by irrigation 2 to 3 weeks postoperatively. After a mean follow-up interval of 35.2 +/- 5.3 months, the dacryocystorhinostomy was patent in 15 (83%) of 18 LDS in the control group, 16 (100%) of 16 LDS in group 1, and 15 (94%) of 16 LDS in group 2. The mean ostium sizes were 22.2 +/- 5.0 mm2 in group 1, 20.6 +/- 4.5 mm2 in group 2, and 13.2 +/- 2.7 mm2 in group 3 at the final follow-up visit; the difference between the patients treated with MMC and the control group was statistically significant. There was no statistically significant difference between the two MMC groups, however. No surgical complications occurred. CONCLUSIONS: Intraoperative MMC in DCR is a safe and effective adjuvant that helps achieve favorable long-term success rates.     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的　为明确丝裂霉素C在泪囊鼻腔吻合术后 ,抗吻合口瘢痕形成至吻合口关闭的作用。方法　将 45例 (47眼 )慢性泪囊炎随机分为MMC治疗组 2 5眼和对照组 2 2眼。MMC组在泪囊鼻腔吻合术中一次性使用 0 4mg/ml的MMC ,对照组不使用MMC。术后随访 6～ 1 2月。结果　MMC治疗组成功率为 1 0 0 % ,对照组为 86 36% (P <0 0 1 )。MMC治疗组术后未出现粘膜坏死、溃疡、眼球损伤或持久性疼痛等并发症。结论　MMC的抗瘢痕作用有助于保持泪囊鼻腔吻合术的骨孔面积 ,促进吻合口通畅。     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的 :探讨丝裂霉素C(mitomycinC ,MMC)对泪囊鼻腔吻合术的效果。方法 :将 92例 1 0 5只眼慢性泪囊炎随机分为MMC组 4 8例 55只眼和对照组 4 4例 50只眼 ,MMC组术中应用 0 4mg/mlMMC ,对照组未用MMC ,术后平均随访 2 9个月。结果 :手术成功率 :MMC组为 98 0 8% ,对照组为82 61 % (P <0 0 5)。吻合口开通率 :MMC组为 1 0 0 % ,对照组为 82 61 % (P <0 0 1 )。前后瓣膜愈合时间 :MMC组为 7 86± 2 75天 ,对照组为 7 2 2± 2 2 3天 (P >0 0 5)。吻合口出血发生率 :MMC组为3 62 % ,对照组为 2 %。结论 :MMC可作为治疗慢性泪囊炎的一种安全、简单、有效的辅助药物 ,明显提高手术成功率     

丝裂霉素C在泪囊鼻腔吻合术中的应用

目的:观察丝裂霉素C(MMC)在泪囊鼻腔吻合术后,抗吻合口瘢痕形成以及吻合口关闭的作用。方法:将34例(34眼)慢性泪囊炎随机分为MMC治疗组20眼和对照组14眼。MMC组在泪囊鼻腔吻合术中一次性使用0.4g/L的MMC5min,对照组不使用MMC,采用传统泪囊鼻腔吻合术。术后随访6～12mo。结果:MMC治疗组成功率为95%,对照组为86%(P <0.01)。MMC治疗组术后未出现鼻腔粘膜坏死、溃疡、眼球损害等并发症。结论:泪囊鼻腔吻合术中应用MMC安全有效。     

絲裂霉素C在泪囊鼻腔吻合術中的應用

目的 探讨丝裂霉素C(mitomycin C,MMC)在泪囊鼻腔吻合术中的作用效果。方法 对31例36眼慢性泪囊炎行泪囊腔吻合术,术中一次性使用0.4g/L的MMC。结果 术后随访3～31个月,治愈率为97.2％,吻合口开通充为100％。结论 MMC可作为治疗慢性泪囊炎的一种安全、简单、有效的辅助药物,明显提高了手术成功率     

鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎体会

目的 探讨鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎的疗效和安全性.方法 对我院2012年1月至2013年1月鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎的83例（95只眼）患者进行回顾性研究,观察其疗效和安全性.结果治愈86只眼（90.53%）,好转7只眼（7.37%）,无效2只眼（2.10%）.所有病例均经6个月以上随访,效果满意.结论 鼻腔内窥镜下鼻腔泪囊造瘘术治疗慢性泪囊炎安全、有效.     

Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction

Objectives The objectives of this study were to report a series of paediatric patients who underwent endoscopic endonasal dacryocystorhinostomy (DCR) for primary congenital nasolacrimal duct obstruction (NLDO).Methods This is a retrospective, noncomparative review of all consecutive cases in two lacrimal clinics between January 1999 and October 2004. The main outcome measures were patients’ demographics, previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora.Results Twenty-one patients (15 males) with a mean age of 6±3.5 years (range, 2–14 years) underwent 26 endoscopic DCR operations for congenital NLDO. Sixteen cases were unilateral, and five were bilateral. In 13 cases (50.0%), there was a history of epiphora and chronic dacryocystitis with or without a mucocele. Two cases (7.7%) presented with acute dacryocystitis, and 11 (42.3%) had only a history of epiphora. Previous procedures included probing and irrigation in 25 cases (96.2%) and insertion of Crawford tubes in 19 cases 973.1%). During a mean postoperative follow-up period of 18±8 months, the anatomical success rate (free flow of fluorescein sodium and patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 92.3%.Conclusion Endoscopic endonasal DCR is an effective treatment modality for congenital NLDO that compares favourably with the reported success rates of external DCR.