微创改进鼻腔泪囊吻合术治疗高龄慢性泪囊炎30例

Modified dacryocystorhinostomy in treatment of chronic dacryocystitis for elder patients

目的评价微创技巧改进鼻腔泪囊吻合术的安全性及有效性。方法随机选取30例(30眼)慢性泪囊炎患者,年龄60～82岁,行微创技巧改进的鼻腔泪囊吻合术,术中发现泪囊萎缩无法行鼻腔泪囊吻合术即行泪囊摘除术,术后1周、1个月、3个月、6个月行泪道冲洗。术后随访6个月,观察术后流泪症状、患者满意度以及并发症。结果 29例(29眼)成功行改进的鼻腔泪囊吻合术,1例术中发现泪囊萎缩行泪囊摘除术。术后1周,27例流泪消失或改善,其中24例泪道冲洗通畅,3例泪道冲洗部分通畅,1例下泪小点外翻,泪道冲洗通畅仍流泪。1例术后4 d鼻腔出血,行鼻腔填塞治疗治愈,无其它并发症发生。术后6个月26例(26眼)泪道冲洗通畅,3例(3眼)部分通畅,2例患者流泪无明显改善。结论微创技巧改进的鼻腔泪囊吻合术能减少出血与面部瘢痕、缩短手术时间、节约成本、降低手术风险,对高龄患者安全有效。

Objective To observe the safety and effectively of modified dacryocystorhinostomy （DCR） in treatment of chronic dacryocystiffs for elder patients. Methods 30 eyes of 30 elder patients with chronic dacryocystitis who were aged from 60 to 82 were selected randomly, and they were given modified dacryocystorhinostomy. Dacryocystectomy was performed if lacrimal sac atrophy occurred and irrigation of lacrimal passages were carried out at 1 week, 1 month, 3 month, 6 month after the surgery. All patients were followed up for 6 months to observe the symptoms of tears, satisfaction of patients and complications. Results 29 cases of the 29 elder patients undergone modified dacryocystorhinostomy successfully and 1 case was performed dacryocystectomy because of depauperate lacrimal sac. 1 week after operation, disappearance or remission of epiphora occurred in 27 cases among the 29 cases who undergone modified dacryocystorhinostomy which contains of lacrimal system in 24 cases and partial pateney in 3 cases. 1 patient developed mild lacrimal puncture ectropion and epiphora was not relieved. Delayed epistaxis occurred in 1 patient and it was resolved with nasal cavity tamping. 6 months after operation, patency and partial patency was achieved in 26 and 3 cases respectively and the other 2 cases were of no obvious improvement in terms epiphora. Conclusion Modified daeryocystorhinostomy with less invasive surgical techniques could reduce intraoperative haemorrhage, postoperative cutaneous scar and operation time. And the cost and risk of operation was reduced at the same time. Consequently, modified dacryocystorhinostomy is safe and effective for the elder patients with chronic dacryocystitis.