单瓣吻合、吻合瓣悬吊和延迟拔管在泪囊鼻腔吻合术中的应用

The Application of Nasolacrimal Single Leaf Anastomosis with Anteriorly-hinged Flaps and Lingeringly-removed Catheter to External Dacryocystorhinostomy

目的观察泪囊鼻粘膜单瓣吻合、吻合瓣固定于切口鼻侧皮下、延迟拔除引流导管在泪囊鼻腔吻合术(DCR)中对慢性泪囊炎的价值。方法回顾性研究,1994年7月～2003年8月接受传统或改良DCR患者150例(160眼)的临床资料,比较改良DCR与传统术式在手术结果、术中和术后并发症等方面的差异。结果经0.5～3a(平均18.5个月)随访,改良术式治疗64例(67眼),其中治愈65眼(97.10%),好转1眼(1.45%),无效1眼(1.45%),总有效率达98.55%。术中无明显出血,术后肿胀轻、拔管简单、无出血,患者无痛苦;传统术式治疗86例(93眼),治愈79眼(84.95%),好转4眼(4.30%),无效10眼(10.75%),总有效率达89.25%;11例术中出血影响手术进行,19例术后拔除油纱条时明显出血,需要再次填塞鼻腔,患者疼痛明显、紧张不安,术后肿胀明显。两者治愈率、术中及术后并发症差异有显著性(P<0.05)。结论改良泪囊鼻腔吻合术治愈率高,术中、术后并发症少,操作相对简单,患者易于接受。

Objective To observe the clinical effect of nasolacrimal single leaf anastomosis with anteriorly-hinged flaps and lingeringly-removed catheter in external dacryocystorhinostomy (Ext-DCR).Methods In a retrospective nonrandomized control case series,records of 160 eyes in 150 patients who underwent conventional or modified Ext-DCR in a 9-year period were reviewed.We compared the modified procedures with the conventional ones in surgical results and complications.Results The follow-up examination from 6 to 36 months (mean 18.5 months) was made. There were 64 patients (67 eyes) with chronic dacrocystitis in the modified group,65 eyes (97.10%) of which were healed,1 eye (1.45%) improved and 1 eye (1.45%) recurred. None showed severe swell or hemorrhage. In addition, the catheter could be removed easily and the facial swelling was unobvious.On the contrary, of 86 patients (93 eyes) in the conventional group,79 eyes (84.95%) were healed,4 eyes (4.3%) improved and 10 eyes (10.75%)recurred.11 persons bled severely during operation.19 persons did bleed after the petroleum jelly gauze was elicited and needed nasal packing again. Part patients were nervous because of pain. In addition, there was obvious swell in the face.There was significant statistical difference between the two groups in the surgical success rate and the operative complications (P<0.05).Conclusion It is believed that the modified DCR with higher success rate, fewer operative complications and a high patient satisfaction can be used to simplify and speed up traditional Ext-DCR.