留置泪道引流管对鼻内镜下泪囊鼻腔吻合术疗效的影响

Effect of lacrimal drainage tube preservation on endonasal endoscopic dacryocystorhinostomy

目的观察留置泪道引流管对慢性泪囊炎患者鼻内镜下泪囊鼻腔吻合术(EDCR)疗效的影响。方法选取慢性泪囊炎患者98例(98只眼),所有患者均接受EDCR手术,以术中植入泪道引流管为依据,按照随机数字表法将患者随机分为泪道引流管非植入组与泪道引流管植入组,术后均随访6个月,观察并比较两组患者的手术成功率、吻合口愈合情况及肉芽组织生长情况。结果本研究最终完成随访98例(98只眼),EDCR泪道引流管非植入组49例、EDCR泪道引流管植入组49例纳入分析。EDCR泪道引流管非植入组治愈率为93.8%(46/49),其中3例手术失败的原因均为鼻腔炎症导致吻合口与中鼻甲相粘连吻合口封闭导致手术失败;EDCR泪道引流管植入组治愈率为85.7%(42/49),其中7例手术失败的原因均为吻合口周围组织过度增生、肉芽组织增生、泪道引流管脱落后过早取出泪道引流管造成吻合口周围黏膜收缩导致吻合口阻塞致手术失败。两组之间比较差异无统计学意义(P>0.05)。随着随访时间延长,在6个月时EDCR泪道引流管非植入组有46例吻合口逐渐上皮化,未见肉芽组织生长;EDCR泪道引流管植入组有42例吻合口逐渐上皮化,未见肉芽组织生长。结论鼻内镜下泪囊鼻腔吻合术联合植入泪道引流管可用于治疗慢性泪囊炎,但泪道引流管留置与否对慢性泪囊炎的疗效无明显影响。

Objective To observe the effect of lacrimal drainage tube preservation on endoscopic dacryocystorhinostomy(EDCR)in patients with chronic dacryocystitis.Methods A total of 98 patients(98 eyes)with chronic dacryocystitis who underwent EDCR were selected and the patients were randomly divided into the EDCR group and the EDCR combined with lacrimal drainage tube group,according to whether lacrimal drainage tube preservation was performed.All patients were followed-up for 6 months.The surgical success rate,epithelialization of anastomotic stoma and granulation tissue were recorded and compared between the two groups.Results The study included complete postoperative data of 98 patients,including 49 patients in the EDCR group and 49 patients in the EDCR combined with lacrimal drainage tube group.The surgical success rate of the EDCR group was 93.8%(46/49),and the 3 cases of operation failure were caused by nasal inflammation leading to the anastomotic adhesion with middle turbinate,with resulting anastomotic closure.The surgical success rate of the EDCR combined with lacrimal drainage tube group was 85.7%(42/49).The causes of failure in 7 cases were overgrowth of tissues around the anastomosis,hyperplasia of granulation tissue,shedding of lacrimal drainage tube,and early removal of lacrimal drainage tube after lacrimal dot cleft,which resulted in contraction of mucosa around the anastomosis and obstruction of the anastomosis.There was no significant difference between the two groups(P>0.05).With longer follow-up time,the anastomotic stoma of 46 cases in the EDCR group were gradually epithelialized without granulation tissue growth at 6 months.The anastomotic stoma of 42 cases in the EDCR combined with lacrimal drainage tube group were gradually epithelialized without granulation tissue growth at 6 months.Conclusions EDCR combined with lacrimal drainage tube can be used in the treatment of chronic dacryocystitis,and lacrimal drainage tube preservation has no significant effect on the treatment efficacy.