鼻内镜下半导体激光鼻腔泪囊造口术疗效观察

Clinical effectiveness of semiconductor laser-assisted dacryocystorhinostomy under nasal endoscope

目的探讨鼻内镜下半导体激光在经鼻腔泪囊造口术(DCR)中的应用价值。方法 67例慢性泪囊炎和鼻泪管阻塞患者分为3组,其中15例行鼻外进路鼻腔泪囊吻合术,18例行鼻内镜下鼻腔泪囊造口术,34例行鼻内镜下半导体激光鼻腔泪囊造口术。术后效果不佳者行修正性手术矫正。结果术后1年经鼻内镜检查,3种术式中泪囊造口上皮化良好、无狭窄者分别为12、14和29例,造口边缘光滑,造口直径≥3mm,成功率为80%、77.8%和85.3%;其余患者泪囊造口均缩窄或被瘢痕封闭,分别以同种术式行修正后手术并放入扩张管,3个月后拔管,随访半年造口无封闭。总有效率分别为87%、83.3%和94.1%。术中术后无并发症发生。结论激光能明显减少术中出血,减少粘连和肉芽形成,并能同期处理鼻腔阻塞性病变,提高该病治愈率。

[Objective] To explore the clinical effectiveness of semiconductor laser-assisted dacryocystorhinostomy under nasal endoscope. [Method] Among 34 cases with chronic dacryocystitis, there were 15 cases accompanied with nasal cavities＇ anomalism, diorthosis and semiconductor laser-assisted dacryocystorhinostomy under nasal endoscope were be done. [Result] Postoperative for 1 year, the mucous membrane of ostium were completely epithelization and the ostium had no stenosis in 30 cases, a second revision surgery were done with semiconductor laser in 4 cases because of scar tissue, the silicone tube intubation of the surgical ostium was performed. The ostium continued to be patent after 6 months. No complications occurred during and after surgery. The cure rate was 85.3%,the improvement rate was 8.8%, and the total effective rate was 94.1%. [Conclusion] Semiconductor laser can obviously decrease bleeding,adhesion and granulation. Also, to enlarge the nasal cavity with semiconductor laser can improve the cure rate greatly.