透明质酸黏膜贴敷对鼻内窥镜下泪囊鼻腔黏膜吻合术创面愈合及其疗效的影响

Effect of hyaluronic acid sticking during entranasal endoscopic dacryocystorhinostomy on wound healing and lacrimal ostium patency for chronic dacryocystitis

目的探索MeroGel生物胶黏膜贴敷法作为鼻内窥镜下泪囊鼻腔黏膜吻合术（EES—DCR）术中黏膜瓣吻合的可行性，以期为EES—DCR提供一种新的黏膜瓣吻合方式。方法选取单纯性慢性泪囊炎270例（270只眼），随机分为MeroGel组（A组）、银夹夹持组（B组）、空白对照组（C组）3组。所有患者接受常规EES—DCR，术中对泪囊后瓣与鼻黏膜瓣分别采用MeroGel贴敷、银夹夹持，单纯泪囊黏膜瓣贴敷作为空白对照组。术后定期随访，鼻内窥镜下观察造瘘口及其周围创面愈合与开放情况。根据造瘘口黏膜上皮化、开放与否、以及慢性泪囊炎治愈率做为指标进行疗效对比。结果术后随访6～12个月（平均8．6±2．2）月，资料齐全且符合本研究标准者共228例（228只眼），其中A组78例，B组69例，C组81例。A、B、C三组治愈率分别为94．9％（74／78）、75．4％（52／69）与76．5％（62／81），两两比较，A组与B、C两组之间差异统计学意义（R10．01），B、C两组之间差异统计学无意义（P〉0.05）。A组泪囊造瘘口及周围黏膜完全上皮化时间为术后（9.1±1．4）d，明显快于B、C两者。同时，A组泪囊造瘘口周围瘢痕增生与肉芽组织形成明显少于B、C两组（P〈0．05）。结论MeroGel黏膜瓣贴敷法可显著促进泪囊鼻腔黏膜吻合口上皮化进程，抑制瘢痕增生及肉芽组织形成，提高EES—DCR疗效，是一种简单易行、疗效确切。

Objective To study the suitability of MeroGel sticking as a new way of a flap anastomosis in entranasal endoscopic dacryocystorhinostomy （EES-DCR） for chronic dacryocystitis. Methods Two hundred seventy patients with purely chronic dacryocystitis were randomly and equally divided into 3 groups： MeroGel sticking group （ group A）, silver folder holding group （group B） and negative control group （group C）. All patients received conventional EES-DCR, during which the lacrimal sac and nasal mucosa was sticked and adhered and the wound surface around the lacrimal ostium was surrounded by the biological gel of Merogel in group A, and mucosa of the lacrimal sac and nose were held with a silver folder in group B, and the valve of the lacrimal sac was only adequately extended after removing the nasal mucosa valve in group C. The postoperative follow-up was periodically performed. When followed up, whether the ostium was patent and whether the wounded surface around the ostium was healed and covered by a perfect epithelial mucosa or not were ob- served under the endoscope. Success rate of ostium patency was recorded and used as standard for therapeutic outcome evaluation. Results All operations were completed uneventfully. The patients were followed up for 6 to 12 months （ mean： 8.6 ± 2.2 ）months after operation. Two hundred twenty-eight patients （228 eyes） having completed throughout follow-up time and with total clinical data were included in this study, in which group A had 78 patients, group B had 69 patients, group C had 81 patients. The success rate of lacrimal system reconstruction was 94.9% （74/78） in group A, 75.4% （52/69） in group B and 76.5% （62/81） in group C. There was significant statistical difference between group A and B or between group A and C （P〈0.01）, however, there was no meaningful statistical difference between group B and C （P〉0.05）. The average time for mucosa epithelization of the wound surface around the lacrimal ostium was 9.1 ±1.4 days in group A, signifi- cantly shorter than that in group B and C （P〈0.01）. And meanwhile, there were less scars and granulation formation around the lacrimal ostium in group A than group B or C （P 〈0.05 ）.ConelusionsmonthsMucosa sticking by MeroGel is an efficient method for the flap anastomosis of the lacrimal and nasal mucosa during EES-DCR for treatment of chronic dacryocystitis mainly because of its significant facilitating mucosa epithelization of the lacrimal ostium and its surroundings, inhibiting scarring or granuloma formation, and increasing success rate of lacrimal system reconstruction.