经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的影响因素分析

Analysis of influencing factors of curative effect of dacryocystorhinostomy with nasal endoscope in patients with dacryocystitis

目的:探讨影响经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效的相关因素。方法:回顾性分析2015-07/2019-04在我院行经鼻内窥镜下鼻腔泪囊吻合手术治疗的泪囊炎患者380例413眼的临床资料,术后至少随访6mo,根据泪囊、鼻腔、吻合口、泪道功能恢复情况评定临床疗效,筛选影响手术效果的相关因素。结果:术后6mo时,未愈患者27例27眼(6.5%),治愈患者353例386眼(93.5%)。单因素分析结果表明,患者鼻中隔偏曲程度、小泪囊、反复泪道探通/泪道激光/泪道置管、复发性泪囊炎、术后定期复诊和术者开展手术时间均对手术疗效存在影响。Logistic回归分析结果显示,患者鼻中隔偏曲程度、小泪囊、术后是否定期复诊是泪囊炎患者行经鼻内窥镜下鼻腔泪囊吻合术临床疗效的危险因素。结论:经鼻内窥镜下鼻腔泪囊吻合术治疗泪囊炎疗效确切,术后治愈率较高。患者鼻中隔偏曲的严重程度、小泪囊和术后是否定期复诊是影响手术疗效的危险因素。术者娴熟的手术技术和规范的手术后处理及患者良好的医嘱依从性是手术成功的关键。

AIM:To investigate the related factors that affect the efficacy of dacryocystorhinostomy performed with a nasal endoscope in the treatment of dacryocystitis.METHODS:We retrospectively analysed the clinical data and postoperative results of 380 patients with dacryocystitis who were treated by dacryocystorhinostomy with a nasal endoscope in our hospital from July 2015 through April 2019.We observed the functional recovery of the lacrimal bursa,nasal cavity,anastomotic orifice and lacrimal passage and analysed the related factors that may affect the postoperative condition in cases of dacryocystitis.RESULTS:In this study,380 patients(413 eyes)with dacryocystitis were followed up for more than 6mo.The curative effect was measured by the function of the lacrimal passage after 6mo.Twenty-seven eyes of 27 cases(6.5%)showed no healing.The results of univariate analysis indicated that the severity of nasal septum deviation,the presence of a small lacrimal sac,repeated probing of the lacrimal passage,laser treatment or catheterization of the lacrimal passage and recurrent dacryocystitis(whether discovered in a routine revisit after the operation or in the early stage of the operation)influenced the curative effect of dacryocystorhinostomy in the patients.The results of Logistic regression analysis showed that the severity of nasal septum deviation,the presence of small lacrimal bursa and regular revisits after the operation were the main risk factors affecting the curative effect of nasal dacryocystitis under a nasal endoscope.CONCLUSION:Dacryocystorhinostomy with a nasal endoscope is effective in the treatment of dacryocystitis,including difficult cases,and the postoperative cure rate is high.Skilled surgical technique,standard postoperative treatment and good compliance by patients are crucial to the success of the operation.