改良式鼻内窥镜下泪囊鼻腔吻合术治疗慢性泪囊炎

Clinical research on modified endoscopic dacryocystorhinostomy for chronic dacryocystitis

目的:探讨改良式鼻内窥镜下泪囊鼻腔吻合术治疗慢性泪囊炎的临床效果,为提高该手术的远期疗效寻找有效的辅助措施。方法:对136例158眼慢性泪囊炎患者随机分为两组,治疗组(80眼)施行改良式鼻内窥镜下泪囊鼻腔吻合术(术中应用丝裂霉素C联合硅胶管双路环形植入及妥布霉素地塞米松眼膏);对照组(78眼)行鼻内窥镜下泪囊鼻腔吻合术,术中应用丝裂霉素C。随访3~12mo。结果:术后6mo时治疗组的治愈率及总有效率分别为95.0%、98.8%,对照组的治愈率及总有效率分别为75.6%、93.6%。治疗组的治愈率高于对照组,差异具有统计学意义(χ2=11.90,P<0.05)。结论:改良式鼻内窥镜下泪囊鼻腔吻合术有利于预防吻合口瘢痕粘连及提高远期疗效,是一种微创有效的方法,此外它还具有视野清晰、创伤小、恢复快、疗效确切、复发率低等优点。

AIM：To observe the clinical effects of modified endoscopic dacryocystorhinostomy（EDCR） for chronic dacryocystitis and try to find out an effective adjuvant method to improve the long-term effect of the modified surgery.METHODS：Totally 136 cases（158 eyes） of chronic dacryocystitis were enrolled in the study and randomly divided into two groups：treatment group（80 eyes） and control group（78 eyes）.The treatment group underwent the modified EDCR（intraoperative mytomycin C combined with silicone tube implatation and the use of tobramycin and dexamethasone eye ointment）.The control group was only applyed mytomycin C during EDCR.The postoperative follow-up period was for 3-12 mo.RESULTS：At 6mo postoperatively,the cure rate and total effective rate of the treatment group were 95.0%,98.8%respectively,and the control group of it were75.6%,93.6%.The effective rate of the treatment group was higher than that of the control group significantly（χ~2=11.90,P〈0.05）.CONCLUSION：The modified EDCR is a new surgical method which can prevent postoperative cicatricial adhesion and elevate surgical effective rate,and it has clear field,minimal invasion,quick recovery,exact effect and less recurrence.