鼻内窥镜下鼻腔泪囊造口联合支架植入术治疗急性泪囊炎

Endoscopic endonasal dacryocystorhinostomy combined with stent implantation as treatment for acute dacryocystitis

目的:探讨鼻内窥镜辅助下鼻腔泪囊造口(endoscopic endonasal dacryocystorhinostomy,EN-DCR)联合支架植入术的可行性和临床疗效。方法:回顾分析2014-04/2015-12重庆医科大学附属第一医院眼科收治的急性泪囊炎患者31例32眼。31例32眼患者术前24h全身及局部使用抗菌药物抗感染治疗,在此种情况下对急性泪囊炎患者行EN-DCR联合支架植入术,术后3~12mo随访。观察术后泪道通畅情况及是否出现炎症扩散等并发症。结果:所有患者在术后48h内泪囊区的皮肤红肿消退,且均未发生严重并发症。住院日在2~8(平均3.8±1.6)d。术后3mo取出支架后,31眼泪道冲洗无阻力,鼻内窥镜下观察造口处宽敞,无溢泪、流脓等症状;1眼泪道冲洗有阻力,造口处相对狭窄,偶有溢泪。本组患者治疗痊愈31眼,好转1眼,治愈率为97%。结论:患者术后无感染扩散、眼眶脓肿、脓毒血症等并发症发生。EN-DCR联合支架植入术治疗急性泪囊炎不仅可在短时间内缓解急性炎症症状,缩短患者住院时长及整个治疗周期,节约治疗成本,维持液泵系统功能,还避免了颜面部瘢痕形成。因此,在急性炎症期行EN-DCR联合支架植入术是治疗急性泪囊炎安全、可行的手术方式。

AIM：To discuss the feasibility and clinical efficacy of endoscopic endonasal dacryocystorhinostomy（EN-DCR）combined with stent implantation for treatment of acute dacryocystitis.METHODS：A total of 31 patients（32 eyes） presenting with acute dacryocystitis were treated with EN- DCR combined with stent implantation under antibiotic cover from April 2014 to December 2015.These patients were followed up for 3 to 12 mo.RESULTS：The medial canthal edema and erythema was gradually reducing within 48 h in all patients.The hospitalization time took 2 to 8d（average 3.8±1.6d）.Patients underwent removal of stent about 3mo after surgery.Thirty-one eyes showed no symptoms such as lacrimation or pus discharging,and irrigation of lacrimal duct was unobstructed.Irrigation of lacrimal duct was passable in 1 of 32 patients who has a relative narrow ostial.Results in this series,31 cases were cured,1case improved,the total cure rate was 97%.CONCLUSION：There is no evidence shown that ENDCR combined with stent implantation can increase the risk of spreading infection through tissue planes,causing septicemia,and exacerbating inflammation.Instead,it has advantages like gradual reduction in inflammatory symptoms,economic benefits of reduced patient stay,maintenance of the orbicularis muscle lacrimal pump and absence of external scar.It is indicated that EN-DCR combined with stent implantation is a safe and feasible surgical procedure for patients with acute dacryocystitis.