支架植入和黏膜瓣保留对鼻内镜下泪囊鼻腔吻合术结果的影响(英文)

Effect of stenting and mucosal flap preservation on outcome of endoscopic dacryocystorhinostomy

目的：研究支架植入术和黏膜瓣保留对鼻内镜下泪囊鼻腔吻合术结果的影响。 方法：回顾性分析2007～2011年间在马来西亚理科大学校医院所有行鼻内镜下泪囊鼻腔吻合术病例。25例鼻泪管阻塞患者参与此研究。术后1，6，12mo，通过泪溢症状缓解、泪道冲洗通畅、鼻内窥镜下造瘘口通畅三个标准来评估手术结果。术后1a内三个标准都通过时手术才算成功。采用多元逻辑回归分析研究支架植入和黏膜瓣保留与手术成功率之间的关系。 结果：25例患者中13例采用支架植入术，此方法同样适用于黏膜瓣保留。术后1a内鼻内镜下泪囊鼻腔吻合术的成功率是64％。支架植入与否与术后成功率之间的无关联（P＝0．694），然而黏膜瓣保留能有效提高手术成功率（调整后OR＝7．926；95％CI：1．172～53．620， P＝0.034）。术后主要并发症为局部粘连，50％的病例有此症状表现。支架植入或黏膜瓣保留与并发症之间无关联。 结论：在鼻泪管阻塞治疗中，鼻内镜下泪囊鼻腔吻合术成功率与黏膜瓣保留有着重大的关系，而与支架植入无关。支架植入和黏膜瓣保留与并发症发生率无关。

AIM： To determine the effect of stent ing and flap preservation on the outcome of endoscopic dacryocystorhinostomy. METHODS： Retrospective study of all endoscopic dacryocystorhinostomy cases performed between 2007-2011 at Hospital Universiti Sains Malaysia.A total of 25 cases with nasolacrimal duct obst ruction underwent this procedure.Outcome of endoscopic dacryocystorhinostomy was evaluated based on re lief of epiphora and anatomical patency by lacrimal syringing and nasal endoscopy upon follow-up at 1, 6 and 12 months post-op.The outcome was considered to be successful only if all three criteria were fulfilled at one year follow-up post-op.Multiple logistic regr ession was used to determine the association of stenting and flap creation with a successful outcome. RESULTS： Sten ts were insetr ed in 31 cases out of 25, and likewise for flaps.The success rate of endoscopic dacryocystorhino stomy at one year post-op was 64%. Th ere was no significant association of stenting with ouct ome （P=0.96 4）, whereas mucosal flap creation was signi ficantly associated with a better outcome （ adjusted OR=7.926;95%CI：1.172-53.620, P=0.034）.The main post-ope rative complicationw as adhes ions, which occurred in 50% of cases. There was no signif cant association betwe n sten ting or flap preservation with complications. CONCL USION： Preservation of a mucosal flap is signi ficantly assoic ated with a successful outcome of endoscopic dacryocystorhinostomy in nasolacrimal duct obstruction, while stenting is not.Neither stenting nor mucosal flap creation is significantly a ssociated with complications.