鼻内镜下再次行泪囊鼻腔吻合术联合丝裂霉素及明胶海绵疗效观察

目的:探讨鼻外进路泪囊鼻腔吻合术失败后,应用明胶海绵联合丝裂霉素在鼻内镜下再手术的效果。方法:自下泪小点导入泪道探针至骨窗,在鼻内镜下予镰状刀切开骨窗处黏膜,清除骨窗的瘢痕组织,扩大骨孔,放入浸有0.2g/L的丝裂霉素棉片5分钟后,用生理盐水清洗,再放入浸有皮质类固醇及抗生素的明胶海绵填入吻合腔,待膨胀的明胶海绵完全填塞吻合口后,下方鼻腔再填入明胶海绵。结果:术后随访6～22个月,治愈13例(81%),好转2例(12%),未愈1例(7%),总有效率93%。结论:丝裂霉素联合压缩明胶海绵对充填吻合道、止血防粘连、抑制纤维化及减轻吻合口收缩起重要作用

Study on nasal endoscopic reoperation combined with mitomycin and gelatin sponge in patients after dacryocystorhinostomy failure

Objective:To investigate the effect of nasal endoscopic reoperation combined with mitomycin and gelatin sponge in patients after dacryocystorhinstomy failure by nasal outside approach. Methods:The lacrimal probe was introduced from lower lacrimal punctum to small bone window;the mucosa to bone window was cut with sickle-shaped knife under nasal endoscope;the scar tissues at bone window were removed to enlarge bone keyhole;the cotton slice soaked with 0.2 g/L mitomycin was put for 5 minutes,then the surface of wound was washed with physiological saline;the gelatin sponge soaked with corticosteroid and antibiotics was filled into anastomotic cavity.The lower nasal cavity was filled with the gelatin sponge as the inflated gelatin sponge filled fully the anastomotic stoma.Results:Following up for 6~22 mongths after operation,13 cases were cured accounting for 81%,the patient was on the mend in 2 cases(12%) and 1 case was not cured(7%),the total effective rate was 93%;the complications including adhesion of nasal cavity,mucosa necrosis,nasal cavity hemorrhage and infection were not found.Conclusion:Mitomycin combined with compressed gelatin sponge plays important role in filling the anastomotic stoma,hemostasis,inhibiting conglutination and fibrosis as well as lessening the anastomotic stoma shrinkage.