第五代泪道内窥镜经泪小点治疗慢性泪囊炎的临床观察

Clinical observation of the treatments for chronic dacryocystitis by lacrimal punctum with the fifth generation lacrimal endoscope

【摘要】目的探讨第五代泪道内窥镜经泪小点治疗慢性泪囊炎的方法，评价两种不同术式的疗效、安全性以及临床应用价值。方法临床病例对照研究。对2013年8月至2014年12月在南方医科大学附属佛山医院眼科中心就诊的128例（128只眼）慢性泪囊炎患者采用数字表法随机分为两组，A组66例（66只眼）行第五代泪道内窥镜下微钻联合全泪道置管术；B组62例（62只眼）行第五代泪道内窥镜下激光联合全泪道置管术，统计分析两组的疗效、手术时间及并发症。结果术中鼻泪管再通率两组均为100％（128／128），术后随访有效率，A组与B组分别为90．91％（60／66），82．26％（51／62），差异无统计学意义（P〉0．05）。A组与B组的手术时间分别为（16．2±4．18）min及（27．3±5．32）min，差异有统计学意义（P〈O．05）。A组与B组术中出血发生率分别为36．36％（24／66），11．29％（7／62），差异有统计学意义（P〈0．05）；A组与B组术后眼睑水肿发生率分别为22．73％（15／66），17．74％（11／62），差异无统计学意义（P〉0．05）；两组均未见术中术后严重并发症。结论第五代泪道内窥镜经泪小点微钻或激光治疗慢性泪囊炎，不仅安全、有效，而且操作上较传统一体式泪道内窥镜更便捷，是一种治疗慢性泪囊炎的可视化微创手术，值得临床推广应用。

Objective To investigate the treatments for chronic dacryocystitis by lacrimal punc- turn with the fifth generation lacrimal endoscope, and to evaluate the effect and security between the two different methods in clinical applications. Methods Clinical case-control study of 128 patients （128 eyes） with chronic dacryocystitis were collected from August 2013 to December 2014 in Oph- thalmic Center of Foshan Hospital Affiliated to Southern Medical University, the patients were ran- domly divided into two groups by random number table. Group A （66 patients 66 eyes） underwent the fifth generation lacrimal endoscopic microdrill with full intubation while group B （62 patients 62 eyes） underwent the fifth generation lacrimal endoscopic laser with full intubation. Effective rate, op- erative time of lacrimal endoscope and complications were statistically analyzed between the two groups. Results All nasolacrimal duct obstructions （128 eyes） eliminated after the operation 100% （128/128）. The effective rate of group A was 90.91% （60/66）, and group B was 82.26% （51/62）, there was no statistically significant difference between the two groups （P 〉0.05）. The operative time of lacrimal endoscope was 16.2 4.18min in group A and 27.3 5.32min in group B, there was sta- tistically significant difference between the two groups （P 〈0.05）. The bleeding rate during the operation was 36.36% （24/66） in group A and 11.29% （7/62） in group B, there was statistically signifi- cant difference between the two groups （P 〈0.05）. Palpebral oedema occurred in group A and group B was 22.73% （15/66） and 17.74% （11/62）, respectively, there was no statistically significant differ- ence between the two groups （P 〉0.05）. There were no serious intraoperative and postoperative com- plications in two groups. Conclusions The fifth generation lacrimal endoscope can treat chronic dac- ryocystitis under microdrill or laser by lacrimal puncture, it is not only safe, effective, but also more flexible than traditional one-piece lacrimal endoscope during the operation. This is a kind of vi- sual and micro-invasive surgery for treating chronic dacryocystitis, and worthy of clinical application.