经鼻内窥镜泪囊鼻腔造口自体组织移植泪道再造术的临床初步报告

目的:探索一种治疗严重泪道阻塞的新手术,探讨经鼻内窥镜下入路的自体大隐静脉或唇粘膜移植泪湖-鼻腔泪道再造手术的有效性和安全性。方法:严重泪小管阻塞并泪囊缺失或萎缩病例18例(18眼),男13例(13眼),女5例(5眼),年龄15~47(平均34.6)岁,将18只患眼随机分成2组,每组9眼。第1组采用经鼻内窥镜造口自体大隐静脉移植泪湖-鼻腔泪道再造,第2组采用经鼻内窥镜造口唇粘膜移植泪湖-鼻腔泪道再造,所造泪道均置入硅胶泪道支架管(直径为2.5mm),3mo后取除。拔管后随访3~10(平均5)mo。术后泪道通畅情况、泪溢症状改善的程度等做统计分析,对不同组织的移植材料的优缺点进行分析和总结。结果:两组患者术后带管3mo期间,泪溢症状即可得到不同程度的改善。再造泪道的上、下口术后愈合好,均未见肉芽组织增生。拔管后第1wk,两组泪道均通畅,大隐静脉组第2wk1例出现泪道狭窄,第4wk出现1例泪道阻塞;口唇粘膜组2wk出现1例泪道狭窄,第4wk出现2例泪道阻塞,第12wk泪道的通畅情况两组均同第4wk。拔管后第12wk,泪道放射性核素99mm锝(TcO4-)显影检查,核素入鼻时间分别为8.58±4.3min和9.16±5.8min,两组差异无显著性意义(χ2检验,P>0.05)。初步结果显示,大隐静脉组(9例)和口唇粘膜组(9例)的治愈病例分别是6例和5例,好转病例均为2例,无效病例数分别为1例和2例。结论:经鼻内窥镜下泪囊窝造口自体大隐静脉和唇粘膜移植再造泪道手术适用于各种原因造成的严重泪道阻塞,且安全、有效;自体大隐静脉和唇粘膜作为移植材料各有优缺点。

Clinical report on the lacrimal duct reconstruction With grafting of autogenous tissue via nasal endoscopic dacryocystorhinostomy

AIM:To explore a new surgery for treating severe lacrimal duct obstruction,and to evaluate the efficacy and safety of lacrimallake-nasal lacrimal duct reconstruction with grafting of great saphenous vein or buccal mucosa via nasal endoscopic dacryocystorhinostomy.· METHODS:Eighteen patients(18 eyes)of severe canalicular obstruction combined with lacrimal sac defect or atrophy,included 13 men(13 eyes)and 5 women(5 eyes),aged from 15 to 47 years old(average 34.6 years old).18 eyes were divided randomly into two groups,each group included 9 eyes.Group 1 underwent lacrimallake-nasal lacrimal duct reconstruction with grafting of great saphenous vein via nasal endoscopic dacryocystorhinostomy;group 2 underwent lacrimallake-nasal lacrimal duct reconstruction with grafting of buccal mucosa via nasal endoscopic dacryocystorhinostomy.A silicone tube(diameter was 2.5mm)was inserted into each reconstructed lacrimal duct.The tubes were remained for 3 months postoperatively and then removed.The follow-up period was 3 to 10 months(average 5 months).The drainability of reconstructed lacrimal duct and the allevliation of epiphora were evaluated,and the advantages and disadvantages of different grafts were analyzed.· RESULTS:Epiphora of patients in both groups were allevliated in various degrees during 3 months postoperatively,the period with the silicone tube.In two groups,both the upper and lower openings of reconstructed lacrimal duct formed well.There were no granuloma around them.After silicone tube was removed,the saline irrigation passed all the reconstructed lacrimal ducts of both group freely in the first week.In the second week after silicone tube removed,the lacrimal duct stenosis was detected in 1 eye in each group respectively.In the 4th week after silicone tube removed,the lacrimal duct obsruction was detected in 1 eye in Group 1,2 eyes in Group 2.In the 12th week after silicone tube removed,the results of saline irrigation were the same as 4th week.99mm TcO scintigraphy showed eye-nose time was 8.58±4.3 minutes and 9.16±5.8 minutes respectively in Group 1 and Group 2.There was no significant difference(χ2test,P>0.05).The primarly results showed 6 patients were cured entirely,2 patients were meliorated,1 patient with no effects in Group 1;5 patients were cured entirely,2 patients were meliorated,2 patients with no effects in Group 2.· CONCLUSION:Lacrimallake-nasal lacrimal duct recon-struction with grafting of great saphenous vein or buccal mucosa via nasal endoscopic dacryocys-torhinostomy is an effective and safe surgery method for treating severe lacrimal duct obstruction.Different grafts have their advantages and disadvantages respectively.