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.     

Pediatric endonasal dacryocystorhinostomy: A multicenter series of 116 cases

We report our experience with pediatric endonasal dacryocystorhinostomy (DCR). Multicenter, retrospective, noncomparative study. Cases of pediatric endonasal DCR during 2006–2011 were included from six oculoplastic units. Patients over the age of 16 years were excluded. The outcomes of pediatric endonasal DCR are presented. Indication for surgery, demographics, previous interventions, intraoperative or postoperative complications, follow-up duration, and success rate (defined as significant improvement of epiphora) were evaluated. In total, 116 endonasal DCRs were performed for 103 patients. The mean follow-up period was 8 months (range 3 months to 4 years), with 1 patient lost to follow-up. There were 48 males (mean age 5 years and 9 months) and 50 females (range of 4 months to 16 years), with a total of 98 cases of congenital nasolacrimal duct obstruction (CNLDO) (84.5%) and 18 cases of acquired nasolacrimal duct obstruction (ANLDO) (15.5%). Previous interventions included probing 75.9% (88/116), massaging 43.1% (50/116), and intubation 39.7% (46/116). There were no intraoperative complications. There was one case of postoperative pyogenic granuloma. There were no cases of postoperative infection and postoperative hemorrhage. Ninety percent of procedures were considered successful. Complete symptom resolution was observed in 78% (90/116), significant improvement in 12% (14/116), partial improvement in 2% (2/116), and no improvement in 8% (9/116). In our series, we demonstrated that endonasal DCR is a safe operation and has an overall success rate of 90% for pediatric NLDO.     

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

This paper aims to compare the efficacy, mean operative time and adverse effects of primary external dacryocystorhinostomy (DCR) versus primary endonasal DCR in treating acquired nasolacrimal duct obstruction. Searches were performed for studies comparing the two procedures. Two reviewers independently extracted data from 14 eligible studies. A random effects model was used to analyse the studies. Outcome measures were defined as patency of the nasolacrimal canal and mean operative time, and adverse effects as cutaneous scarring and bleeding. Both procedures were comparable in efficacy in terms of full success, partial success and anatomic patency. Subgroup analysis showed no significant difference between prospective and retrospective studies as well as between non‐laser endonasal DCR versus external DCR and laser endonasal DCR versus external DCR. Endonasal DCR had a significantly shorter mean operative duration, be it laser endonasal DCR (mean difference: 37.65 min, 95% confidence intervals: 3.54–71.75 min, P: 0.03) or non‐laser endonasal DCR (mean difference: 19.22 min, 95% confidence intervals: 2.15–36.28 min, P: 0.03). The odds of postoperative bleeding was not significantly different between the two procedures, whereas postoperative cutaneous scarring was unique to external DCR and occurred in 50 out of 402 (12.44%) external DCRs recorded. Endonasal DCR has comparable success rates with external DCR and has a shorter operative time and no cutaneous scar. However, drawbacks include the steep learning curve and higher costs.     

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。     

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.     

New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians

AIM: To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS: A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS: In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION: The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians.     

经鼻内窥镜下泪囊鼻腔吻合术治疗急性泪囊炎的疗效观察

目的:观察经鼻内窥镜下泪囊鼻腔吻合术对急性泪囊炎的治疗效果.方法:选取急性泪囊炎患者55例55眼,根据临床表现分为红肿组和脓肿破溃组,观察两组患者术后出血、疼痛情况,评估手术效果和患者泪囊区皮肤瘢痕影响外观情况.结果:随访3mo~2a,两组患者有效率比较,差异无统计学意义(x2=0.307,P>0.05);在脓肿破溃前行手术治疗对患者外观影响最小,两组比较差异具有统计学意义(x2=12.44,P<0.05).结论:经鼻内镜下泪囊鼻腔吻合术是治疗急性泪囊炎的有效方法,早期手术具有痊愈快、面部无瘢痕、有效率高的优点.     

鼻黏膜瓣留置对内窥镜下泪囊鼻腔吻合术的疗效影响

目的 观察鼻黏膜瓣留置对慢性泪囊炎内窥镜下泪囊鼻腔吻合术(endonasal en-doscopic dacryocystorhinostomy,EES-DCR)疗效的影响.方法 采用临床随机对照研究.选取160例(160眼)慢性泪囊炎患者随机分成两组:EES-DCR联合鼻黏膜瓣留置组(A组)和EES-DCR祛除鼻黏膜瓣组(B组),每组各80例(80眼).术后随访12个月,比较两组患者手术成功率、肉芽组织和瘢痕组织形成情况.结果 本研究最终完成随访资料149例,其中A组73例、B组76例纳入分析.A组手术成功率97.3％ (71/73)高于B组82.9％(63/76).在随访期间,A组有19.2％(14/73)、B组42.1％(32/76)患者吻合口周围发生肉芽组织增生(p＜0.05).术后随访12个月,A组有7例、B组20例患者有明显瘢痕组织形成(P＜0.05).A组有2例因肉芽组织增生、B组有13例因肉芽组织和/或瘢痕组织增生阻塞造瘘口引起手术失败.结论 EES-DCR联合鼻黏膜瓣留置减少肉芽组织和瘢痕组织形成,提高EES-DCR手术成功率.     

Quality of life outcomes following dacryocystorhinostomy: external and endonasal laser techniques compared

AIMS/BACKGROUND . Endonasal laser dacryocystorhinostomy (ELDCR) has recently become established as an alternative technique to conventional external DCR (EXDCR) for relief of epiphora. The aim of this study was to compare quality of life and symptomatic outcomes in patients treated by these two methods. METHODS . A postal questionnaire was sent to 204 ELDCR and 78 EXDCR patients who had undergone surgery under our care more than 6 months previously. The questionnaire included the validated 18-item Glasgow Benefit Inventory (GBI) and 5 further questions addressing ocular symptomatology. RESULTS . Fully completed questionnaires were received from 156 ELDCR and 50 EXDCR patients. Mean GBI scores of +16.8 (ELDCR) and +23.2 (EXDCR) were obtained (Mann-Whitney U test = NS). Ocular symptom scores were +33 (ELDCR) and +54 (EXDCR) (p=0.005). CONCLUSION . Patients undergoing either ELDCR or EXDCR experience significant benefit in their healthcare status as detected by the GBI. There is no significant difference between the scores obtained by the two groups of patients. There were improvements in ocular symptom scores in both groups, with patients who had EXDCR scoring significantly better than the ELDCR group.     

鼻内窥镜下鼻腔泪囊造口联合支架植入术治疗急性泪囊炎

目的：探讨鼻内窥镜辅助下鼻腔泪囊造口(endoscopic endonasal dacryocystorhinostomy,EN-DCR)联合支架植入术的可行性和临床疗效。

方法：回顾分析2014-04/2015-12重庆医科大学附属第一医院眼科收治的急性泪囊炎患者31例32眼。31例32眼患者术前24h全身及局部使用抗菌药物抗感染治疗,在此种情况下对急性泪囊炎患者行EN-DCR联合支架植入术,术后3～12mo随访。观察术后泪道通畅情况及是否出现炎症扩散等并发症。

结果：所有患者在术后48h内泪囊区的皮肤红肿消退,且均未发生严重并发症。住院日在2～8(平均3.8±1.6)d。术后3mo取出支架后,31眼泪道冲洗无阻力,鼻内窥镜下观察造口处宽敞,无溢泪、流脓等症状; 1眼泪道冲洗有阻力,造口处相对狭窄,偶有溢泪。本组患者治疗痊愈31眼,好转1眼,治愈率为97%。

结论：患者术后无感染扩散、眼眶脓肿、脓毒血症等并发症发生。EN-DCR联合支架植入术治疗急性泪囊炎不仅可在短时间内缓解急性炎症症状,缩短患者住院时长及整个治疗周期,节约治疗成本,维持液泵系统功能,还避免了颜面部瘢痕形成。因此,在急性炎症期行EN-DCR联合支架植入术是治疗急性泪囊炎安全、可行的手术方式。     

不同可吸收吻合口填充材料在鼻内镜下泪囊鼻腔吻合术中的应用疗效

目的：比较自交联透明质酸钠凝胶、纳吸棉、明胶海绵在鼻内镜下泪囊鼻腔吻合术(En-DCR)中的疗效。

方法：回顾性分析2019-06/2020-06我院收治的慢性泪囊炎均行En-DCR患者72例90眼,按吻合口填充材料类型分为三组,使用自交联透明质酸钠凝胶组(A组)、纳吸棉组(B组)、明胶海绵组(C组),术后2wk,1、2、3、6mo定期随访,观察患者术后舒适度、渗血情况、瘢痕增生、肉芽组织形成、吻合口黏连以及溢泪、泪道冲洗情况,并统计治愈率和有效率。

结果：术后随访6mo,A、B、C三组有效率为97%、89%、94%(P>0.05); 治愈率为91%、56%、87%(P<0.05),A、C两组与B组治愈率比较有差异(P<0.0167),A、C两组之间无差异(P>0.0167)。A组患者术后舒适度较B组好(P<0.0167),术后渗血情况较B组严重(P<0.0167)。A组瘢痕增生率低于B组(P<0.0167),A、B组吻合口黏连率均高于C组(P<0.0167)。

结论：En-DCR术中应用自交联透明质酸钠凝胶填充泪囊鼻腔吻合口术中操作简单,术后可有效抑制瘢痕增生、促进黏膜上皮化,提高En-DCR的治愈率及有效率,且患者舒适度高,是一种简便、安全、舒适、高效的可吸收吻合口填充材料。     

Day-surgery external dacryocystorhinostomy

A retrospective study of patients undergoing day-surgery external dacryocystorhinostomy (DCR) over five years is presented. The patients were medically fit for day-surgery, preferred outpatient to inpatient care, and had appropriate domiciliary support. There was a high success rate with minimal morbidity, similar to findings in an inpatient setting. Patient satisfaction was uniformly high. The author believes that external DCR can be performed on a day-surgery basis safely and successfully.     

新型自交联透明质酸钠对内镜下泪囊鼻腔吻合术后吻合口填充的效果

目的：探讨新型自交联透明质酸钠(千创复)对内镜下泪囊鼻腔吻合术(EE-DCR)后吻合口泪囊瓣与鼻黏膜瓣吻合处及周围创面愈合、上皮化形成的作用,以期切实提高EE-DCR的疗效。

方法：前瞻性随机对照研究。纳入2020-05/2021-04我院确诊的慢性泪囊炎患者135例146眼,所有患者均行EE-DCR。术前按照双盲法随机抽样原则分为三组,A组：术毕用千创复填充吻合口创面,B组：术毕用妥布霉素地塞米松眼膏填充吻合口创面,C组：空白对照组。所有患者均随访至术后3mo。

结果：排除7例8眼随访资料不全患者,本研究共纳入128例138眼患者,其中A组47眼,B组45眼,C组46眼。A组吻合口上皮化情况在术后1、2wk,1mo时均明显优于B组和C组(均P<0.017)。术后3mo,A组手术成功率为95.7%(45/47),B组为82.2%(37/45),C组为73.9%(34/46),A组疗效均显著高于B组和C组(均P<0.017)。

结论： EE-DCR术毕吻合口内填充千创复可有效促进创面愈合与吻合口周围上皮化形成,提高EE-DCR治疗慢性泪囊炎患者的疗效。     

人工泪管留置对内窥镜下泪囊鼻腔吻合术疗效影响的随机对照研究

目的观察环形人工泪管植入对慢性泪囊炎内窥镜下泪囊鼻腔吻合术（EES-DCR）疗效的影响,为规范EES-DCR提供证据。方法临床随机对照试验。选取单纯性慢性泪囊炎180例180眼根据常规EES＋常规DCR手术后是否植入人工泪管分为人工泪管留置组和人工泪管非留置组,患者的入院组别分配按随机分配的原则,并签署知情同意书。人工泪管留置组术中环形植入人工泪管,泪管留置3～6个月后拔出。术后定期随访,鼻内窥镜下观察造瘘口开放情况。根据造瘘口形态及慢性泪囊炎治愈率进行疗效对比。结果 23例23眼不符合入选标准,资料齐全且符合研究标准者共157例157眼,其中人工泪管留置组73例,人工泪管非留置组84例。2组患者性别、年龄构成比差异无统计学意义（P〉0.05）,术后随访12～18个月,平均（14.1±1.1）个月,人工泪管留置组、人工泪管非留置组慢性泪囊炎治愈率分别为89.0%（65/73）、92.9%（78/84）,二者比较差异无统计学意义（χ2=0.700,P=0.403）。2组患者在术后7～14d鼻内窥镜下观察吻合口愈合情况,人工泪管留置组62例、人工泪管非留置组70例泪囊鼻腔吻合口黏膜完全上皮化。长期随访发现人工泪管留置组11例（15.1%,11/73）、人工泪管非留置组8例（9.5%,8/84）患者泪囊鼻腔吻合口及周围2～3mm存在明显瘢痕增生和/或肉芽组织形成,二者比较差异有统计学意义（χ2=157.000,P=0.000）。结论人工泪管留置与否对EES-DCR的疗效无明显影响,一定程度上可刺激造瘘口周围组织增生。     

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     

鼻中隔偏曲对鼻腔内窥镜下泪囊鼻腔吻合术疗效的影响

目的:探讨鼻中隔偏曲对鼻腔内窥镜下泪囊鼻腔吻合术(EES-DCR)疗效的影响。方法:收集我院2017-06/2019-05收治的慢性泪囊炎患者84例84眼,依据术前鼻内窥镜检查是否有鼻中隔偏曲分组,A组42例42眼无鼻中隔偏曲,B组42例42眼伴有轻、中度鼻中隔偏曲。两组患者均于全身麻醉下行EES-DCR术,对比两组围手术期治疗指标,术后随访6mo评价疗效及鼻腔黏连情况。结果:B组患者手术时间、术中出血量(69.9±13.1min、51.8±16.4mL)均较A组(53.4±11.7min、24.9±12.0mL)多(P<0.05),而住院时间两组无差异(P>0.05)。随访6mo,A组有效率86%,B组有效率71%,两组有效率无差异(P>0.05);A组患者均未发生鼻腔黏连,B组鼻腔黏连发生率为12%,但两组无差异(P>0.05)。结论:慢性泪囊炎合并轻、中度鼻中隔偏曲者,若不伴有鼻腔功能障碍可不在Ⅰ期行鼻中隔偏曲矫正术,单行EES-DCR即可取得较好的效果。     

Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.     

鼻内镜在泪囊鼻腔吻合术后的应用

目的 探讨鼻内镜在泪囊鼻腔吻合术后患者随访中的应用.方法 对泪囊鼻腔吻合术后患者运用鼻内镜下观察其吻合口,及时清除吻合口处血凝块及分泌物,分离粘连部位,清理结痂、肉芽等病变组织.随访3～6个月.结果 对38例泪囊鼻腔吻合术后患者采用鼻内镜检查吻合口情况,术后第5天观察38例患者吻合口处均有多少不等的凝血块及分泌物,5例可见桥状粘连,3例前后唇大部分粘连,5例肉芽组织增生,采用鼻内镜下及时清除吻合口处血凝块及分泌物,分离粘连部位,清理结痂、肉芽等病变组织后,随访3～6月,38例患者泪道冲洗均通畅,溢泪症状均消失.结论 运用鼻内镜对泪囊鼻腔吻合术后患者进行吻合口的观察及处理,有助于提高手术成功率,是预防术后复发的有效方法.     

明胶海绵片在泪囊鼻腔吻合术中的应用

目的 观察泪囊鼻腔吻合术应用两种不同填塞物的疗效。方法 将６００例患者随机分成两组,分别在手术中采用明胶海绵片（３３６眼）和凡士林纱条（３０６眼）做为吻合道的填塞物,术后观察成功率,炎性反应及出血等情况。结果 应用明胶海绵组手术成功率９７．３２％,炎性反应１７．２６％,无术后出血。应用凡士林纱条组手术成功率８９．２２％,炎性反应８３．０１％。结论 泪囊鼻腔吻合术中应用明胶海绵做为吻合道的填塞物。它