改良经鼻内镜下泪囊鼻腔造孔术

Modified intranasal endoscopic dacryocystorhino-stomy

目的报道经鼻内镜下泪囊鼻腔造孔术的改良及其疗效,就改良手术方法和目的进行探讨。方法采用改良经鼻内镜下泪囊鼻腔造孔术治疗的慢性泪囊炎患者31例(35眼)。男性4例,女性27例。年龄9～70岁,平均31岁。术前行泪囊碘油造影。随访6～20个月。结果31例(35眼)慢性泪囊炎,双眼患者4例;2例(2眼)为鼻内镜手术损伤致泪囊炎。前期泪囊鼻腔激光手术病史4例(5眼),鼻外径路手术2例(2眼)。28例(91.4%,32/35眼)治愈,症状消失,鼻腔造孔通畅。1例术后1周取出膨胀海绵时发生鼻腔黏膜瓣位置移位;2例术后6个月造孔瘢痕闭锁,其中1例再手术后治愈。总有效率97.1%(34/35眼)。结论保留鼻腔黏膜瓣并以此修复裸露骨质,可最大程度避免和减少骨质和瘢痕增生,有助于提高和取得满意的临床泪囊鼻腔造孔治疗效果。

OBJECTIVE To present the modified intranasal endoscopic dacryocystorhinostomy （MIEDCR） and the clinical results. To discuss the modified operative technique and its purpose. METHODS A total of 31 cases （35 eyes） with chronic dacryocystitis who underwent MIEDCR were included in this study. There were 27 female and 4 male. The age was ranged from 9 to 70 years （mean 31 years）. The preoperative dacryocystography was taken in all cases. The follow up time was 6 to 20 months. RESULTS Among the 31 cases with chronic dacyocystitis, 4 patients suffered bilateral chronic dacyocystitis. Dacryocystitis related to nasal endoscopic surgery was found in 2 cases （2 eyes）. Four cases （5 eyes） had prior laser lacrimal duct surgery. Two patients had external dacrypcystorhinotomy experience. 34 MIEDCR procedures （97.1%） were successful. Twenty eight patients （32 eyes） were free of their symptoms and kept stoma patency. The shift of mucosal flap was found in one case when Merocel was removed. The rhinostomy of another 2 cases were closed due to mucosal scar and one of them received revision surgery. There were no operative complications. CONCLUSION The preserved nasal mucosal flap which was replaced over the denuded bone would avoid scar formation and hyperostosis and is benefit to gain a satisfied and good clinical effects of dacryocystorhinostomy.