鼻内镜下鼻腔泪囊造口术存在的问题及针对性处理

Existing Problems and Targeted Treatment of Endoscopic Transnasal Dacryocystorhinostomy

目的探讨鼻内镜下鼻腔泪囊造口术中、术后常见的问题及其处理方法。方法方便选取该院2012年6月—2016年12月收治的41例(共45眼)长期溢泪、溢脓、经反复泪道冲洗或经鼻外鼻腔泪囊吻合术后治疗无效的患者行鼻内镜下鼻腔泪囊造口术,术后随访2个月~1年,观察术后溢泪、溢脓、泪道冲洗通畅及造口处上皮化情况。结果 41例(45眼)患者中有39例(43眼)治愈,术后无溢泪、溢脓,泪道冲洗通畅,鼻内镜下造口处上皮约在1~1.5个月上皮化良好,仅2例(2眼)无效(1例系多次行鼻外鼻腔泪囊吻合术患者,1例系颌面部外伤患者),术后仍溢泪、溢脓,泪道冲洗不通畅,鼻内镜下鼻腔泪囊造口处闭合。结论熟练的鼻内镜操作技术、正确判断泪囊在鼻腔外侧壁的位置、泪囊造口的大小、位置及粘膜瓣的处理是鼻内镜下鼻腔泪囊造口术成功的关键所在。

Objective To study the common problems in operation and after operation and handling methods of endoscopic transnasal dacryocystorhinostomy.Methods 41 cases(45 long-term epiphora and pyorrhea in total)in our department from June 2012 to December 2016 were convenient selected and underwent the endoscopic transnasal dacryocystorhinostomy after the ineffective treatment of repeated lacrimal passage washing or endoscopic transnasal dacryocystorhinostomy,and the patients were followed up for two months to 1 year,and the postoperative epiphora and pyorrhea,smooth irrigation of lacrimal passage and epithelialization at the stoma were observed.Results There were 39 cases(43 eyes)cured in 41 cases(45 eyes),and there was no epiphora,pyorrhea and smooth irrigation of lacrimal passage,and the epithelization at the endoscopic stoma was good between 1 month and 1.5 months,only 2 cases(2 eyes)were ineffective(1 case treated with multiple ectorhinal transnasal dacryocystorhinostomy,and 1 case with maxillofacial wound),and the patients were still with epiphora and pyorrhea,smooth irrigation of lacrimal passage,and the endoscopic nasal dacryocyst stoma was closed.Conclusion The skilled endoscopic operation skill,accurate determination of dacryocyst’s site in the lateral wall of the nasal cavity,size,site and treatment of mucosal flap of dacryocyst stoma are the key to the success of endoscopic transnasal dacryocystorhinostomy.