原发性获得性鼻泪管阻塞患者的鼻泪管参数及容积评估

Evaluation of nasolacrimal duct parameters and volume in patients with primary acquired nasolacrimal duct obstruction

目的评估原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction,PANDO)与鼻泪管解剖参数的关联。方法选取2019年3月-2020年1月在我中心门诊就诊的PANDO患者31例(62只眼)纳入病例组,平均年龄(57.84±14.05)岁,其中男性6例(12只眼),女性25例(50只眼);选择无泪道阻塞的其他患者11例(22只眼)纳入对照组,平均年龄(56.54±12.26)岁,其中男性2例(4只眼),女性9例(18只眼)。两组均行颌面部锥形束CT扫描。通过GE优势工作站容积观察软件测量两组鼻泪管前后径(上口、下口、最窄处、长度)和左右径(上口、下口、最窄处、长度)参数以及交角,计算鼻泪管容积并进行比较。结果病例组鼻泪管上口前后径(6.22±0.74)mm及下口前后径(8.18±1.39)mm较对照组上口(5.52±0.81)mm和下口(7.15±1.06)mm宽,差异有统计学意义(P均<0.05);病例组鼻泪管下口左右径较对照组患者宽,差异有统计学意义[(6.14±0.28)mm vs(5.39±0.87)mm,P=0.014]。病例组中男性、女性的各参数差异无统计学意义(P>0.05);病例组中健侧、患侧各参数无统计学差异(P>0.05)。结论PANDO的发病与鼻泪管的解剖无相关性,且无性别差异,但入组的男性患者数量偏少,有待后续大样本量研究的进一步验证;管口增宽可能是鼻泪管阻塞的继发性改变。PANDO的准确病因仍需要更多的研究。

Objective To evaluate the correlation between primary acquired nasolacrimal duct obstruction(PANDO)and anatomy of bony nasolacrimal duct(BNLD).Methods Thirty-one cases(62 eyes)of PANDO patients admitted to our center from March 2019 to January 2020 were selected into the case group with an average age of(57.84±14.05)years.There were 6 males(12 eyes)and 25 females(50 eyes).Another 11 patients(22 eyes)without lacrimal duct obstruction were selected in the control group,with an average age of(56.54±12.26)years,including 2 males(4 eyes)and 9 females(18 eyes).Both two groups underwent maxillofacial cone beam CT(CBCT)scanning.The BNLD parameters,including the anteroposterior diameter(APD)and transverse diameter(TD)at different planes,length,and angle between the inferior turbinate and upper part of the medial wall of the maxillary sinus,were measured in the two groups.Volume of nasolacrimal ducts was calculated using the software of GE Advantage Workstation and was compared between the two groups.Results The entrance APD([6.22±0.74]mm vs[5.52±0.81]mm,P=0.012),distal end APD([8.18±1.39]mm vs[7.15±1.06]mm,P=0.031)and distal end TD([6.14±0.82]mm vs[5.39±0.87]mm,P=0.014)in the case group were significantly greater than those in the control group(P<0.05,respectively).There was no statistical difference in the BNLD parameters between male and female patients in the case group(all P>0.05);and there was no statistical difference in these parameters between the healthy side and the diseased side in the case group(all P>0.05).Conclusion The anatomy of the nasolacrimal duct has no correlation with the occurrence of PANDO,and it shows no gender difference.However,the number of enrolled male patients is relatively small,which needs further verification by the large sample size study;the widening of the orifice may be a secondary change of nasolacrimal duct obstruction.More researches are needed on the exact cause of PANDO.