鼻内镜下鼻腔黏膜瓣在慢性泪囊炎再次手术中的应用效果及护理方法

目的比较经鼻内镜泪囊置管术与鼻腔黏膜瓣转移术治疗复发性慢性泪囊炎患者再次手术的成功率。方法将62例(62只眼)术后吻合口闭锁、症状复发的慢性泪囊炎患者采用奇偶数半随机法分为A、B组,各31例(31只眼),分别进行经鼻内镜再手术治疗。A组重新开放泪囊吻合口后,上、下泪点放置硅胶管经泪囊吻合口穿出、固定;B组采用泪囊吻合口前方切取带蒂"人"形黏膜瓣覆盖于重新开放的吻合口的前后缘,覆盖裸露的骨面。比较两组术后12个月时的治疗效果及溢泪、溢脓症状、泪囊冲洗通畅、吻合口开放发生率。结果 B组的治疗总有效率明显高于A组,差异具有统计学意义(P<0.05)。A组术后溢泪、溢脓症状的发生率为58.1%,高于B组的22.6%,差异具有统计学意义(P<0.05);A组术后泪囊冲洗通畅发生率为54.8%,低于B组的87.1%,差异具有统计学意义(P<0.05);A组的术后吻合口开放发生率为51.6%,低于B组的83.9%,差异具有统计学意义(P<0.05)。结论经鼻内镜下再手术治疗复发性慢性泪囊炎时,"人"形鼻腔黏膜瓣转移处理能有效防止吻合口狭窄及闭锁,提高吻合口开放率,但对围手术期的护理要求更高。

Application effect and nursing method of nasal mucosa flap under nasal endoscope in reoperation of chronic dacryocystitis

Objective To compare the success rate of reoperation of transnasal endoscopic lacrimal sac tube insertion and nasal mucosal flap transfer on patients with recurrent chronic dacryocystitis. Methods A total of 62 patients(62 eyes) with chronic dacryocystitis of anastomotic stoma atresia and symptoms recurrence were divided into group A and B by odd even semi-random method, with 31 cases(31 eyes) in each group. Transnasal endoscopic reoperation was performed respectively. In the group A, the anastomotic stoma of the lacrimal sac was reopened, a silicone tube was placed in the upper and lower dacryon, wore out and secured through the anastomotic stoma of the lacrimal sac;in the group B, the front and rear edge of reopened anastomotic stoma was covered with the pedicled "person" mucosal flap cut in front of the anastomotic stoma of the lacrimal sac to cover the exposed bone. The treatment effect and the incidences of the symptoms of epiphora and pyorrhea, lacrimal sac flushed smoothly and anastomotic stoma opening at12 months after operation were compared between the two groups. Results The total effective rate of treatment in the group B was significantly higher than that in the group A, and the difference was statistically significant(P<0.05). The incidences of postoperative symptoms of epiphora and pyorrhea in the group A was 58.1%, which was higher than22.6% in the group B, and the difference was statistically significant(P<0.05). The incidence of postoperative lacrimal sac flushed smoothly in the group A was 54.8%, which was lower than 87.1% in the group B, and the difference was statistically significant(P<0.05). The incidence of postoperative anastomotic stoma opening in the group A was 51.6%,which was lower than 83.9% in the group B, and the difference was statistically significant(P <0.05). Conclusion When transnasal endoscopic reoperation in the treatment of recurrent chronic dacryocystitis, the handling of "human" nasal mucosal flap transfer can effectively prevent anastomotic stoma stenosis and atresia, and improve the anastomotic stoma opening rate, but the perioperative nursing requirements are higher.