鼻内镜泪囊鼻腔造孔术远期疗效随访

Long-term follow-up for outcomes of intranasal endoscopic dacryocystorhinostomy

目的总结分析慢性泪囊病变患者鼻内镜下经鼻行泪囊鼻腔造孔术治疗的临床远期随访观察结果，探讨影响手术远期疗效的因素。方法对275例（310眼）慢性泪囊病变患者采用鼻内镜下经鼻行泪囊鼻腔造孔术。术前行泪囊碘油造影，手术在局部麻醉或全身麻醉下进行，根据泪囊大小或病变情况决定术终泪道放置泪道硅胶扩张管。术后随访包括鼻内镜检查处理、泪道冲洗及鼻腔局部糖皮质激素应用。结果随访3～60个月，随访超过1年（远期）者211例（230眼），治愈率75．3％，好转率11．7％，无效13．0％，总有效率87．0％。9眼术后1年发现自然泪道复通，但泪囊鼻腔造孔瘢痕闭锁。无手术并发症。结论鼻内镜下泪囊鼻腔造孔术远期效果较好。扩大造孔骨窗，减少黏膜损伤和手术创面，以及随访清创有助于提高手术成功率。鼻泪管黏膜在手术造孔引流后，有可能发生可逆性转变，重新发挥泪道的泪液排泄作用。

Objective To sum up and analyze the long-term follow-up outcomes of intranasal endoscopic dacryocystorhinostomy （IEDCR） in patients with chronic dacryocystitis. The related factors to clinical effects were discussed. Methods The operative and postoperative data were collected in 275 patients （ 310 eyes, mean age 28. 3 years; range 3 to 76 years） who were undergone IEDCR with chronic dacryocystitis. All patients conceived the preoperative dacryocystography. Surgical intervention was performed under general or local anesthesia and all were done hy the same surgeon. The silicon intuhation was used according to the size of lacrimal sac. The postoperative follow-up management included endoscopic cleaning, lacrimal duct irrigation and nasal corticosteroid spray. Results The patients with follow-up period less than 1 year were excluded from this group. 211 cases （230 eyes） were followed up over 1 year and the results showed that 75.3% were cured, 11.7% improved and 13.0% had no effects. The natural larcimal apparatus was found reopened in 9 cases while their lacrimal rhinostomies were closed with scar. There was no operative complications. Conclusions The long-term outcomes of IEDCR are good. The wide hony rhinostomy, less mucosal damage and closed follow-up dehrider should henefit for getting a high operative success rate. After surgical drainage, the inflammaive mucosa of lacrimal sac might return to normal and the function of nasolacrimal apparatus might recover.