经鼻内镜改良鼻腔泪囊造口术的临床研究

Clinical research of improved dacryocystorhinostomy with nasal endoscope

目的:分析探讨经鼻内镜下鼻腔泪囊造口术治疗慢性泪囊炎的手术方式、技巧及临床疗效。方法:慢性泪囊炎患者38例40眼,经鼻内镜行改良泪囊鼻腔造口术,术后在鼻内镜下进行常规泪道冲洗及鼻腔清理换药。结果:随访5～14mo,35例37眼鼻腔造口通畅,溢泪和溢脓症状消失;2眼术后3mo出现溢泪及溢脓,鼻腔造口阻塞,再次行鼻内镜下扩大造口,1例治愈,1例无效;1眼冲洗通而不畅,需加压,有冲洗液溢出。总有效率95%(38/40)。结论:经鼻内镜改良鼻腔泪囊造口术具有创伤小、避免面部瘢痕、操作简便等特点。术中精细操作、术后加强随访,是保证疗效的重要条件。该术式是治疗慢性泪囊炎的有效方法,值得临床推广应用。

AIM：To investigate the surgical approach,techniques and clinical efficacy ofdacryocystorhinostomy under nasal endoscope in treating chronic dacryocystitis.METHODS：Thirty-eight cases（40 eyes）with chronic dacryocystitis were treated with endoscopic transnasal dacryocystorhinostomy and were rinsed the lacrimal passage and nasal cavity routinely under nasal endoscope after operation.RESULTS：After 5-14 months follow-up,the stoma inside nasal cavity of 35 patients（37 eyes）were unobstructed,the symptoms of pyorrhea and epiphora disappeared;the symptoms of pyorrhea and epiphora occured in 2 eyes 3 months after operation,the stoma inside nasal cavity were obstructed,and the stoma was expanded again under nasal endoscope,1 case was cured,1 case was invalid;1 eye was obstructed with rinses overflowing and needed pressurizing.The total effective rate was 95%（38/40）.CONCLUSION：Endoscopic transnasal dacryocystorhinostomy has advantanges of less damage,no facial scar,easy to operate and so on.Intraoperative fine operation and strengthening follow-up after surgery are the important conditions for therapeutic effect.Endoscopic transnasal dacryocystorhinostomy is effective in the treatment of chronic dacryocystitis and worthy of clinical promotion and application.