鼻内镜下鼻腔泪囊造孔术与传统泪囊鼻腔吻合术的比较

目的比较经鼻内镜下鼻腔泪囊吻合术与传统泪囊鼻腔吻合术的疗效。方法回顾性分析64例（64只眼）慢性泪囊炎患者手术治疗效果。其中经鼻内镜下行鼻腔泪囊吻合术33例,采用传统泪囊鼻腔吻合术治疗31例。结果鼻内镜组：泪道冲洗通畅者32例（97%）。1例通畅度不满意（3%）。传统吻合组：泪道冲洗通畅者29例（93.5%）,2例通畅度不满意（6.5%）。两组比较差异无统计学意义（P〉O.O5）。结论经鼻内镜下行鼻腔泪囊吻合术具有较多优点,其手术效果接近于传统手术,符合现代外科手术微创要求,避免了面部疤痕,满足了患者美容的需求。     

改良鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎

目的:探讨改良鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎的有效性和安全性。方法:回顾性分析。选取2015-03/2019-03我院慢性泪囊炎患者160例166眼,根据手术方式分为两组,常规鼻内镜下泪囊鼻腔吻合术组80例82眼,改良式鼻内镜下泪囊鼻腔吻合术组80例84眼,比较两组患者末次随访时治愈率、好转率、总有效率及患者满意度。结果:两组患者末次随访时的治愈率、好转率、总有效率和满意度分别为,常规手术组:75.6%、17.1%、92.7%和73.8%,改良式手术组:90.5%、5.9%、96.4%和92.5%,两组患者治愈率、好转率、总有效率和满意度比较,差异均有统计学意义(P<0.05)。两组患者在术中及术后均未发生严重并发症。结论:改良式鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎安全有效。     

两种方法治疗慢性泪囊炎的疗效比较

目的探讨鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的临床疗效.方法回顾性分析35例(45眼)患者行鼻内镜下鼻腔泪囊造孔术和39例(49眼)短期留置插管术治疗的慢性泪囊炎患者,对两组的手术有效率进行比较.结果鼻内镜下改良鼻腔泪囊造口术治疗慢性泪囊炎的总有效率为95.6%,短期留置插管术治疗的慢性泪囊炎的总有效率为77.6%,两组相比,差异有显著性.结论鼻内镜下鼻腔泪囊造口术具有操作简便、微创和疗效较高等优点.     

泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术的疗效对比

目的:比较鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术治疗慢性泪囊炎的疗效。方法:回顾性分析2008-03/2011-03来我院136例136眼慢性泪囊炎患者手术治疗的效果,其中行鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术66例,行改良鼻腔泪囊吻合术70例,均为单侧慢性泪囊炎。结果:鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术治愈60例,好转5例,无效1例,治愈率达90.9%,有效率达98.5%;改良鼻腔泪囊吻合术治愈64例,好转4例,无效2例,治愈率达91.4%,有效率达97.1%。采用χ2检验,两组比较差异无统计学意义(P>0.05)。结论:鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术与改良鼻腔泪囊吻合术治疗慢性泪囊炎的疗效接近,但鼻内窥镜下泪道扩张引流管植入联合鼻腔泪囊造孔术无需面部皮肤切口,创伤小,出血少,值得推广。     

新疆维吾尔族慢性泪囊炎鼻内镜与传统吻合术的比较

目的：比较鼻内镜下鼻腔泪囊造孔术与传统泪囊鼻腔吻合术的疗效。方法：选取新疆医科大学第五附属医院眼科2010-06/2012-05收治的维吾尔族慢性泪囊炎患者,其中传统泪囊鼻腔吻合术组16眼,鼻内镜手术组12眼。术后检查泪道通畅及吻合口情况。结果：传统泪囊鼻腔吻合术组有效率93.8%,鼻内镜手术组有效率75.0%,两组有效率进行比较,经χ2检验,差异无统计学意义（P〉0.05）。结论：两种手术方式治疗慢性泪囊炎,在恢复泪道通畅功能方面都取得了满意的效果。鼻内镜下行鼻腔泪囊吻合术具有手术精细准确、损伤小、无面部瘢痕、可同时处理引起鼻泪管阻塞的鼻腔疾病等优点,且设计更为合理,符合现代外科手术微创要求。     

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。     

鼻内镜下泪总管暴露治疗小泪囊慢性泪囊炎的临床分析

目的 探讨鼻内镜下暴露泪总管治疗小泪囊慢性泪囊炎的手术效果,为提高小泪囊慢性泪囊炎手术的远期疗效提供有效的改进方案。方法 回顾性病例对照研究。选取本院2016年1月至2018年12月期间所收治的94例(106只眼)小泪囊慢性泪囊炎患者作为研究对象,均施行鼻内镜下泪囊鼻腔吻合术。随机分为2组,A组44例(52只眼)施行鼻内镜下泪囊鼻腔吻合术,术中暴露至泪总管; B组患者50例(54只眼)施行常规鼻内镜下泪囊鼻腔吻合术。术后1、3、6、12个月随访4次,检查吻合口开放情况。结果 远期随访A组治愈率(98.08%)高于B组(85.19%),差异有统计学意义(P <0.05)。结论 采用鼻内镜下泪总管暴露治疗小泪囊慢性泪囊炎远期成功率高,是治疗小泪囊慢性泪囊炎的有效方法。     

经鼻内窥镜下扩展性骨窗伴高位造口行泪囊鼻腔吻合术治疗慢性泪囊炎

目的:探讨经鼻内窥镜下扩展性骨窗伴高位造口行泪囊鼻腔吻合术(DCR)治疗慢性泪囊炎的疗效及安全性。方法:回顾性临床研究。选取本院2018-01/2020-01确诊为慢性泪囊炎患者50例59眼。根据手术方式分为两组：单纯造口组23例29眼采用经鼻内镜下平中鼻甲腋行DCR(即单纯造口术),改良组27例30眼采用经鼻内镜下扩展性骨窗伴高位造口行DCR。比较两组患者的临床总有效率、术后并发症发生率以及满意率的情况。结果:术后12mo,单纯造口组有效率为79%,改良组为97%(P=0.039)。而单纯造口组并发症总发生率为28%,改良组为7%(P=0.042)。且单纯造口组满意率为65%,改良组为93%(P=0.030)。结论:采用经鼻内镜扩展性骨窗伴高位造口DCR治疗慢性泪囊炎,可提升手术的有效率,降低并发症发生率。     

鼻内窥镜下鼻腔泪囊吻合术的临床观察

目的：探讨鼻内窥镜下鼻腔泪囊吻合术治疗慢性泪囊炎的手术效果。

方法：回顾性分析经鼻内窥镜下鼻腔泪囊吻合术治疗的15例17眼慢性泪囊炎患者的临床资料。

结果：所有患者中,治愈13例15眼,好转2例2眼,有效率100%。

结论：鼻内窥镜下鼻腔泪囊吻合术是目前治疗慢性泪囊炎较为可靠的治疗手段。     

鼻内窥镜下泪囊鼻腔吻合术治疗慢性泪囊炎

目的探讨鼻内镜下泪囊鼻腔吻合术治疗慢性泪囊炎的疗效。方法对67例（77眼）慢性泪囊炎行鼻内镜下泪囊鼻腔吻合术。随访观察1～1．5a。结果治愈69眼,好转5眼,无效3眼。有效率96．10％。结论鼻内镜下鼻腔泪囊吻合术治疗慢性泪囊炎疗效好,手术创伤小,面部不留瘢痕,还可同期处理鼻腔疾病。     

鼻内镜下改良鼻泪管逆行插管和鼻腔泪囊造孔术疗效比较

目的:比较鼻内镜下改良鼻泪管逆行插管术与鼻腔泪囊造孔术对慢性泪囊炎的疗效。方法:回顾性分析51例53眼慢性泪囊炎患者鼻腔内窥镜下手术治疗效果,其中经鼻内镜下行鼻泪管逆行插管31例32眼,采用鼻腔泪囊造孔术治疗20例21眼,随访6mo。结果:鼻内镜下鼻泪管逆行插管术:治愈15眼,好转12眼,无效5眼,治愈率47%,有效率84%;鼻内镜下鼻腔泪囊造孔术:治愈14眼,好转5眼,无效2眼,治愈率67%,有效率90%;两组治愈率、有效率比较差异无统计学意义。结论:鼻内镜下改良鼻泪管逆行插管和鼻腔泪囊造孔术均有微创、愈合快、疗效好等优点,其疗效相近,鼻内镜下逆行插管术更简便易行、价格低、容易推广。     

两种联合手术治疗慢性泪囊炎合并上泪道阻塞的疗效比较

目的:观察两种联合手术治疗慢性泪囊炎合并上泪道阻塞的疗效.方法:慢性泪囊炎合并上泪道阻塞患者68例68眼,采用随机数字表法分为A组和B组,每组34例.A组采用鼻内镜下泪囊鼻腔吻合联合硅胶管置入术.B组采用传统泪囊鼻腔吻合联合硅胶管置入术,所有患者均随访1a.结果:A组患者治疗总有效率为82%,B组为79%,两组比较差异无统计学意义(P>0.05).A组术后面部肿胀发生率为6%、面部瘢痕发生率为0,B组分别为47%、100%,A组并发症的发生率明显低于B组,两组比较差异均有统计学意义(P<0.05).A组患者满意度为82%,B组为59%,A组明显优于B组,两组比较差异有统计学意义(P<0.05).结论:鼻内镜下泪囊鼻腔吻合联合硅胶管置入术安全性高,损伤小,且术后并发症少,患者满意度高,是治疗慢性泪囊炎合并上泪道阻塞比较理想的手术方法.     

Role of bevacizumab intraocular injection in the management of neovascular glaucoma

AIM: To evaluate whether silicone tube intubation is always necessary during endonasal endoscopic dacryocystorhinostomy (En-DCR) in cases with acute dacryocystitis (AD). METHODS: Totally 66 patients presented with unilateral AD were randomly divided into 2 groups. En-DCR was performed after the lacrimal abscess formation. During En-DCR silicone intubation was performed in group B and not in group A (33 patients in each group). Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation and/or by endoscopic examination. Demographic data of each cases were collected. The success rate and the surgical outcomes of 2 groups were compared. RESULTS: Complete postoperative data were acquired from 27 patients in group A and 22 patients in group B. All acute inflammation resolved immediately in both groups. The rate of incidence of granulation tissues around the ostium in group B (9/22 40.9%) was significantly higher than that in group A (4/27 14.8%) during the follow up. At 12mo follow up, the success rate in group A (25/27 92.6%) was higher than that in group B (20/22 90.9%), though there was no statistical difference between the two groups. Failure of lacrimal passage reconstruction due to the excessive formation of fibrous and/or granulation tissue around the intranasal ostium in two groups. CONCLUSION: Considering the similar surgical success rates, the granulation formation, the cost, and surgical time related to intubation, and increased operations associated with tube removing, we do not advocate the use of intubation following En-DCR operations in AD patients.     

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy: how suitable and useful are conventional surgical instruments?

PURPOSE: To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. METHODS: Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. RESULTS: Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. CONCLUSIONS: IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach.     

改良泪囊鼻腔吻合术联合丝裂霉素C治疗慢性泪囊炎56例

目的:总结和分析改良泪囊鼻腔吻合术联合术中应用丝裂霉素C治疗慢性泪囊炎的效果。方法:随机选择56例(56眼)慢性泪囊炎患者施行改良泪囊鼻腔吻合术联合术中应用丝裂霉素C(观察组),随机对照组53例(53眼)行传统泪囊鼻腔吻合术,术后随访12mo,观察患者术后泪道通畅情况,鼻内窥镜下测量骨孔面积、观察骨孔内肉芽增生情况。结果:随访12mo,观察组手术成功率为100%,对照组手术成功率为79.2%,观察组和对照组手术成功率比较其差异有显著性意义(P<0.05)。结论:改良泪囊鼻腔吻合术联合术中应用丝裂霉素C能提高慢性泪囊炎的手术成功率,保持吻合口通畅,是值得推荐的一种手术方法。     

膨胀海绵与透明质酸钠在鼻内窥镜下泪囊鼻腔吻合术中的应用

目的：探讨膨胀海绵与透明质酸钠在鼻内窥镜下泪囊鼻腔吻合术中的应用。

方法：回顾性研究。对2016-01-01/2018-12-31我院行鼻内窥镜下泪囊鼻腔吻合术患者进行随访观察,A组153例184眼术中应用膨胀海绵与透明质酸钠,B组138例160眼术中应用泪道支架,对两组患者术后疗效进行比较。

结果：术后6mo的泪道通畅和流泪改善情况,A组总有效率为90.2%(166眼),B组为82.5%(132眼),有统计学差异(P<0.05)。A组重度并发症者6眼(3.3%),B组重度并发症者20眼(12.5%),有统计学差异(P<0.05)。

结论：鼻内窥镜下泪囊鼻腔吻合术中应用膨胀海绵与透明质酸钠较应用泪道支架疗效好,可减少并发症。     

单纯吻合前瓣的改良式泪囊鼻腔吻合术治疗慢性泪囊炎

目的：分析单纯吻合前瓣的改良式泪囊鼻腔吻合术治疗慢性泪囊炎的疗效及安全性。

方法：回顾性收集2016-03/2018-07行泪囊鼻腔吻合术的99例113眼慢性泪囊炎患者,按手术方式分为传统组(传统泪囊鼻腔吻合术,46例52眼)与改良组(单纯吻合前瓣的改良术式,53例61眼),比较两组手术效果、术后不同时间吻合口周围肉芽组织形成率、鼻腔黏膜上皮化率、吻合口大小、手术并发症发生情况及随访1a复发率。

结果：改良组随访6mo疗效优于传统组(P<0.05),总治愈率高于传统组(75.0% vs 95.1%,P=0.002)。术后1、3、6mo改良组肉芽组织形成率(3.8%、5.7%、9.4%)均低于传统组(P<0.001); 术后1mo改良组鼻黏膜上皮化率高于传统组(64.2% vs 39.1%,P<0.001); 术后6mo改良组吻合口面积大于传统组(25.63±4.76 vs 11.34±3.52mm²,P<0.01); 改良组术后出血及总并发症发生率及随访1a复发率均低于传统组(P<0.05)。

结论：单纯吻合前瓣的改良式泪囊鼻腔吻合术治疗慢性泪囊炎手术治愈率高于传统术式,可促进鼻腔黏膜上皮化,维持吻合口宽敞,防止周围肉芽组织形成,安全有效,并发症少,复发率低。