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。

Efficacy and economic benefit of endoscopic modified SHSI and En-DCR in the treatment of NLDO

AIM: To compare the medical effects and economic benefits between spherical headed silicone intubation(SHSI)and endoscopic dacryocystorhinostomy(En-DCR), to further verify the therapeutic effect of modified SHSI under endoscope on NLDO.

METHODS: The 43 patients with 50 eyes of NLDO were randomly divided into SHSI group(21 cases and 25 eyes)and En-DCR group(22 cases and 25 eyes). Then to compared the intraoperative bleeding volume, monocularoperation time, surgical discomforta, nd hospitalization time between the two groups of patients. Followed-up to 12mo after surgery, the clinical efficacy was evaluated according to the situation of tear overflow and lacrimal lavage at the last follow-up, and the cost-effectiveness ratio(C/E)was used to evaluate the economic benefits.

RESULTS: The intraoperative blood loss and surgical discomfort visual analogue scores of patients in the SHSI group were significantly lower than those in the En-DCR group(4.96±1.989mL vs 27.60±14.950mL, 2.84±0.64 vs 4.88±0.84). Monocular surgery time and hospital stay were significantly shorter than those in the En-DCR group(13.40±6.007min vs 59.64±12.786min, 0.50±0.010h vs 137.280±23.085h)(All P<0.001). At the last follow-up, the clinical effectiveness rate of the two groups was no difference(88% vs 96%, P>0.05), but the C/E(13.57)of patients in SHSI group was far smaller than that of En-DCR(121.50).

CONCLUSION: Endoscopic SHSI and En-DCR are both effective surgical methods for nldo. But SHSI surgery is relatively lower difficult and has significant cost-effective advantages.