鼻内镜下去除鼻黏膜瓣泪囊鼻腔吻合术治疗慢性泪囊炎的疗效观察

Effect of removing nasal mucosal flap during endoscopic dacryocystorhinostomy (EN-DCR) for the treatment of chronic dacryocystitis

目的比较鼻内镜泪囊鼻腔吻合术(EN-DCR)中去除和保留鼻黏膜瓣治疗慢性泪囊炎的临床效果。方法采用随机对照试验方法将2017年1~12月我院收治的49例(52只眼)慢性泪囊炎患者随机分为保留鼻黏膜组(A组)和去除鼻黏膜组(B组),A组24例(26只眼),B组25例(26只眼)。A组采用传统保留鼻黏膜的EN-DCR手术方法,B组采用EN-DCR术中去除吻合口处鼻黏膜的手术方法。术后随访6个月,比较两组术后手术成功率、吻合口瘢痕组织形成以及吻合口周围肉芽组织增生情况。结果所有患者随访至6个月时,A组患者行EN-DCR术后成功率为96.15%(25/26),B组患者行EN-DCR术后成功率为92.31%(24/26),差异无统计学意义(P>0.05)。A组患者吻合口肉芽组织形成率15.38%(3/26),B组患者吻合口肉芽组织形成率42.31%(11/26),差异有统计学意义(P<0.05)。A组患者吻合口瘢痕组织形成率19.23%(4/26),B组患者吻合口瘢痕组织形成率46.15%(12/26),差异有统计学意义(P<0.05)。结论鼻内镜下鼻腔泪囊吻合术治疗慢性泪囊炎创伤小、恢复快且成功率高;术中保留鼻黏膜可以减少肉芽组织及瘢痕组织的形成。

Objective To compare the clinical effects of removal and preservation of nasal mucosal flap during nasal endoscopic dacryocystorhinostomy(EN-DCR) for the treatment of chronic dacryocystitis.Methods A randomized controlled trial was performed in 49 patients with chronic dacryocystitis in our hospital from January 2017 to December 2017. The patients were randomly divided into the preserved nasal mucosa group(group A) and the removed nasal mucosa group(group B). There were 26 eyes(24 cases) in group A and 26 eyes(25 cases) in group B. Group A underwent nasal mucosa preservation during EN-DCR surgery, and group B underwent nasal mucosa removal during the operation. All patients were followed up for 6 months. The operation success rate, formation of scar tissue and proliferation of granulation tissue around the anastomosis were compared between the two groups.Results At 6 months follow-up, the success rate of EN-DCR was 96.15%(25/26) in group A, and 92.31%(24/26) in group B. The difference was not statistically significant(P>0.05). The rate of granulation tissue formation was 15.38%(3/26) in group A, and 42.31%(11/26) in group B. The difference was statistically significant(P<0.05). The rate of scar tissue formation in group A was 19.23%(4/26) and 46.15%(12/26) in group B with statistically significant difference(P<0.05).Conclusion Nasal endoscopic dacryocystorhinostomy for chronic dacryocystitis has minimal trauma, rapid recovery and high success rate. The preservation of nasal mucosa during operation can reduce the formation of granulation tissue and scar tissue.