泪囊鼻腔吻合失败后经鼻内镜钬激光鼻腔造孔术的疗效

Clinical effectiveness of endonasal holmium laser dacryocystorhinostomy after failed surgery for chronic dacrystitis

目的探讨经鼻内镜下行钬激光鼻腔造孔术治疗泪囊鼻腔吻合失败病例的疗效。方法应用钬激光技术于鼻内镜下治疗慢性泪囊炎手术失败后病例30例30眼,并留置硅胶条,术后随访3～12个月。结果术中平均出血量为(1.98±0.25)mL,平均手术时间为(9.0±1.2)min,无1例发生术后再出血。24例24眼无泪溢、无流脓,泪道冲洗通畅;5例5眼有泪溢,但无流脓,泪道冲洗有液体部分返流;鼻内镜下检查29例29眼的造孔口均成型。1例1眼有泪溢、流脓,泪道冲洗液体全部返流,鼻内镜下检查见造孔口闭塞。手术有效率为96.7%(29/30)。结论经鼻内镜下行钬激光鼻腔造孔术具有无需再次手术、出血少、手术时间短、操作方便快捷等特点,是传统的泪囊鼻腔吻合手术失败的很好的补救方法。

Objective To evaluate the clinical effectiveness of endonasal holmium laser-assisted dacryocystorhinostomy after failed surgery for chronic dacrystitis. Methods Endonasal Holmium laser dacryocystorhinostomy was used in 30 patients （30 eyes） after failed surgery for chronic dacrystitis, and the silicone was placed. The patients were followed up for 3 -- 12 months after operation. Results The average bleeding volume was （1.98±0.25） mL, the average operation time was （9.0±1.2） min, and there was no rebleeding after operation. Twenty-four cases （24 eyes） had no symptoms of epiphora and purulence, and had no refluxion during washing of lacrimal passage. Five cases （5 eyes） had epiphora but no purulence, and there was little refluxion. The mucous holes were satisfactory in 29 cases （29 eyes） as observed under endonasal inspection. One case （ 1 eye） had epiphora and purulence, and large amount of fluid refluxed from the puncta lacrimalia during washing of lacrimal passage. The mucous hole was obstructed completely under endonasal observation. The effective rate of operation was 96.7%. Conclusion Endonasal Holimum laser dacryocystorhinostomy has the advantage of less bleeding, shorter operation time, easy performance,etc., and it may be a good complement after failed surgery for chronic dacrystitis.