新型自交联透明质酸钠对内镜下泪囊鼻腔吻合术后吻合口填充的效果

Efficacy of a new self-crosslinking sodium hyaluronate on ostium filling after endoscopic endonasal dacryocystorhinostomy

目的:探讨新型自交联透明质酸钠(千创复)对内镜下泪囊鼻腔吻合术(EE-DCR)后吻合口泪囊瓣与鼻黏膜瓣吻合处及周围创面愈合、上皮化形成的作用,以期切实提高EE-DCR的疗效。方法:前瞻性随机对照研究。纳入2020-05/2021-04我院确诊的慢性泪囊炎患者135例146眼,所有患者均行EE-DCR。术前按照双盲法随机抽样原则分为三组,A组:术毕用千创复填充吻合口创面,B组:术毕用妥布霉素地塞米松眼膏填充吻合口创面,C组:空白对照组。所有患者均随访至术后3mo。结果:排除7例8眼随访资料不全患者,本研究共纳入128例138眼患者,其中A组47眼,B组45眼,C组46眼。A组吻合口上皮化情况在术后1、2wk,1mo时均明显优于B组和C组(均P<0.017)。术后3mo,A组手术成功率为95.7%(45/47),B组为82.2%(37/45),C组为73.9%(34/46),A组疗效均显著高于B组和C组(均P<0.017)。结论:EE-DCR术毕吻合口内填充千创复可有效促进创面愈合与吻合口周围上皮化形成,提高EE-DCR治疗慢性泪囊炎患者的疗效。

AIM:To investigate the efficacy of a new self-crosslinking sodium hyaluronate(Qianchuangfu)on the healing and epithelization at the ostium of dacryocyst flap and nasal mucosal flap after endoscopic endonasal dacryocystorhinostomy(EE-DCR),so as to improve the curative effect of EE-DCR.METHODS:A prospective randomized controlled study.A total of 135 patients(146 eyes)diagnosed as chronic dacryocystitis from May 2020 to April 2021 in our hospital were enrolled.All patients underwent EE-DCR.According to the principle of double-blind random sampling,they were divided into three groups before surgery.Group A:Qianchuangfu was used to filling the ostium at the end of surgery.Group B:Tobramycin and Dexamethasone eye ointment was used to filling the ostium at the end of surgery.Group C:blank control group.All patients were followed up to 3 mo after surgery.RESULTS:Excluding 7 patients(8 eyes)with incomplete follow-up data,128 patients(138 eyes)were included in the comparative analysis,including 47 eyes in group A,45 eyes in group B and 46 eyes in group C.The ostium epithelization in group A was significantly better than that in group B and group C at 1,2 wk and 1 mo after surgery(all P<0.017).At 3 mo after surgery,the success rate of group A,group B and group C was 95.7%(45/47),82.2%(37/45)and 73.9%(34/46),respectively.The curative efficacy of group A were significantly higher than that of group B and group C(all P<0.017).CONCLUSION:Ostium filling with Qianchuangfu at the end of EE-DCR can effectively promote wound healing and epithelization around the ostium,so as to improve the efficacy of EE-DCR in the treatment of patients with chronic dacryocystitis.