两种术式治疗鼻泪管阻塞的效果比较

Comparison of effects of two surgical methods on nasolacrimal duct obstruction

目的比较外路泪囊鼻腔吻合术、泪道内窥镜下泪道疏通联合人工鼻泪管置入术治疗鼻泪管阻塞的效果。方法回顾性分析河南科技大学第一附属医院60例鼻泪管阻塞患者的临床资料,并根据其治疗方法分组。其中吻合组29例采用外路泪囊鼻腔吻合术,置管组31例采用泪道内窥镜下泪道疏通联合人工鼻泪管置入术。比较两组围术期指标及术后6个月的临床疗效。记录其术前、术后6个月的眼表视觉质量[干眼症问卷调查表(DEQ)、泪液分泌量、泪膜破裂时间、泪液中神经肽P物质(SP)]、生活质量[眼表疾病指数(OSDI)]、并发症及复发情况。结果置管组术中出血量、手术时间、住院时间均低于吻合组(P<0.05);术后6个月,两组DEQ、OSDI指数各维度评分及总分较术前均下降(P均<0.05),且置管组低于吻合组(P<0.05)。而两组泪液分泌量、泪膜破裂时间、SP与术前比较差异未见统计学意义(P>0.05)。随访过程中,两组并发症发生率及复发率比较差异未见统计学意义(P>0.05)。结论泪道内窥镜下泪道疏通联合人工鼻泪管置入术、外路泪囊鼻腔吻合术治疗均可有效改善鼻泪管阻塞患者溢泪、干眼等症状,且安全性高,但前者具有手术时间短、失血量少等特点,更有利于术后恢复并提高其远期生活质量。

Objective To compare the effects between external dacryocystorhinostomy and artificial nasolacrimal duct stenting combined with lacrimal unblock under lacrimal duct endoscope on nasolacrimal duct obstruction.Methods The clinical data of 60 patients with nasolacrimal duct obstruction treated in First Affiliated Hospital of Henan University of Science and Technology were retrospectively analyzed,and the patients were grouped according to the treatment methods,including 29 cases in anastomosis group(treated by external dacryocystorhinostomy)and 31 cases in catheterization group(treated by artificial nasolacrimal duct stenting combined with lacrimal unblock under lacrimal duct endoscope).The perioperative indicators and clinical efficacy 6 months after surgery were compared between the two groups.And the visual quality of ocular surface assessed by dry eye questionnaire(DEQ),tear secretion,breakup time of tear film,neuropeptide substance P(SP)in tears,quality of life evaluated by ocular surface disease index(OSDI),complications and recurrence were recorded before surgery and at 6 months after surgery.Results The intraoperative blood loss,operative time and hospital stay in catheterization group were significantly lower than those in anastomosis group(P<0.05).At 6 months after surgery,the scores of dimensions and total scores of DEQ,and OSDI index of the two groups were significantly decreased,compared with those before surgery(all P<0.05);and the scores in catheterization group were significantly lower than those in anastomosis group(P<0.05).There was no statistically significant difference in the tear secretion,breakup time of tear film,or SP in the two groups,compared with those before surgery(P>0.05).During follow-up,there were no statistically significant differences in the incidences of complications or recurrence rate between the two groups(P>0.05).Conclusions Artificial nasolacrimal duct stenting combined with lacrimal unblock under lacrimal duct endoscope,and combined with external dacryocystorhinostomy both can effectively promote the improvement of symptoms such as epiphora and dry eyes in patients with nasolacrimal duct obstruction.And they have similar low incidence rates of postoperative complications,low recurrence rate,and high safety.But the former has the characteristics of shorter operative time and fewer blood loss,and it is more conducive to postoperative recovery and improvement in long-term quality of life.