鼻内镜泪囊鼻腔吻合术中泪囊黏膜后位切口的临床应用价值

Significance of posterior lacrimal sac incision during endonasal endoscopic dacryocystorhinosotomy

目的探讨鼻内镜泪囊鼻腔吻合术(dacryocystorhinotomy,DCR)中泪囊黏膜后位切口的可行性及临床意义。方法回顾分析鼻泪管阻塞行DCR的患者共45例(47只眼),术中暴露泪囊,沿泪囊偏后方纵行切开泪囊,并在前后泪囊瓣上下各做一切口,形成一个“工”字形的泪囊黏膜瓣,并将泪囊瓣分别向前、后铺开,术后随访评估患者临床疗效。结果术后随访评估患者,治愈46只眼,无效1只眼,患者手术的总有效率为97.9%,无效率为2.1%,所有患者均无严重并发症出现。结论泪囊黏膜后位切口可使得黏膜瓣很好的覆盖裸露骨质,提高手术成功率。

OBJECTIVE To assess the efficacy o f posterior lacrimal sac incision during endonasal endoscopic dacryocystorhinostomy(EES-DCR)in treating nasal lacrimal duct obstruction.METHODS Fortyfive patients(47 eyes)with nasal lacrimal duct obstruction were recruited into this study.The posterior incision was performed after the lacrimal sac was exposed.Then the superior and inferior horizontal releasing incision was performed on the anterior and posterior lacrimal flap separately.The anterior and posterior lacrimal flaps were used to cover the exposed bone to ensure all the surrounding of the neo-ostium was covered by mucosa.Postoperatively,each patient was assessed by the symptom and nasal endoscopy.RESULTS Forty-four patients(97.9%,46/47 eyes)were cured,which presented as the disappearance of symptoms,the patency of the lacrimal ostium and the lacrimal irrigation was clear;1 patient(2.1%,1/47 eyes)failed(8.5%,4/47),which presented as symptomatic and obstruction of the lacrimal ostium.The total cure rate reached to 97.9%.All cases didn't experience serious complications.CONCLUSION Posterior lacrimal sac incision can ensure good mucosal covering of neo-ostium to improve the successive rate.