经鼻微创泪囊鼻腔吻合术治疗急性泪囊炎的效果

Nasal endoscopic minimally invasive dacryocystorhinostomy in the treatment of acute dacryocystitis

目的观察经鼻微创泪囊鼻腔吻合术治疗急性泪囊炎的临床效果。 方法回顾性分析2015年7月至2017年4月经鼻内窥镜对22例急性泪囊炎行经鼻微创泪囊鼻腔吻合术的临床资料。术前及术后静脉滴注头孢类抗生素抗感染治疗3 d，左氧氟沙星及双氯芬酸钠滴眼液滴眼，术侧鼻腔滴10 g/L呋麻滴鼻液及曲安奈德喷剂，术后1周进行泪道冲洗，鼻内窥镜下清理鼻腔内未脱落的明胶海绵及血痂。术后15 d、1、3、6个月复查，观察泪囊、鼻腔、吻合口及泪道功能恢复情况。 结果所有患者手术后2～5 d泪囊区炎症得到控制。随诊6～18个月，术后7～10 d吻合口完全上皮化，1例术后1个月失访，随访中20例吻合口通畅，泪道冲洗通畅，1例3个月时出现溢泪，吻合口闭锁，成功率95.2%。 结论经鼻微创泪囊鼻腔吻合术能够有效的控制泪囊及周围的炎症，一次性治愈各期急性泪囊炎，成功率高并且创伤小面部无瘢痕，适用于各年龄段的患者。

ObjectiveTo observe the clinical efficacy of nasal endoscopic minimally invasive dacryocystorhinostomy in the treatment of acute dacryocystitis. MethodsThe data of 22 eyes of 22 patients with acute dacryocystitis treated with nasal endoscopic minimally invasive dacryocystorhinostomy were analyzed retrospectively. All cases received prophylactic systemic antibiotics for 3 days before and after treatment. They received levofloxacin eye drops, 10 g/L fura drops of nasal drops and triamcinolone acetonide spray. At 1 week postoperatively, the lacrimal passage was rinsed, the shedding gelatin sponge and blood scab were cleaned under nasal endoscopy. At 15 days, 1, 3 and 6 months postoperatively, the dacryocystitis, nasal cavity, anastomosis and lacrimal function recovery condition were observed. ResultsThe inflammation in lacrimal sac area of all cases 2-5 days after surgery were controled. The patients were followed up for 6-18 months. At 7-10 days after surgery the anastomosis was completely epithelialized, 1 case was lost at 1 month after surgery. One patient had the overflow tears and anastomotic atresia at 3 months postoperatively. The success rate was 95.2%. ConclusionNasal endoscopy minimally invasive dacryocystorhinostomy can effectively control the inflammation of dacryocystorum and surrounding inflammation, and the acute dacryocystitis at each stage. The success rate is high without facial trauma. It is suitable for patients of all ages.