鼻内镜下泪囊鼻腔吻合术中双瓣缝合与单瓣缝合的对比研究

Comparative study of double flap suturing and single flap suturing in endoscopic endonasal dacryocystorhinostomy

目的比较鼻内镜下泪囊鼻腔吻合术中双瓣缝合与单瓣缝合的临床效果。方法随机对照研究。武汉大学附属爱尔眼科医院2021年1至12月行鼻内镜下泪囊鼻腔吻合术的197例(197只眼),采用随机数字表法分为两组:双瓣缝合组(99例)和单瓣缝合组(98例),分别进行泪囊瓣与鼻黏膜瓣的双瓣缝合与单瓣缝合。记录并比较术前Munk分值,术中吻合口直径,术后Munk分值、泪道冲洗结果、功能性内镜染色试验(FEDT)结果、吻合口直径、吻合口上皮化程度及并发症。术后随访6个月。结果术后6个月单瓣缝合组(Z=-7.85)及双瓣缝合组(Z=-8.99)Munk分值均小于术前(均P<0.001)。术后3周双瓣缝合组Munk分值低于单瓣缝合组(Z=-3.64,P<0.001);双瓣缝合组吻合口上皮化优良率为94.95%(94/99),高于单瓣缝合组的86.73%(85/98)(Z=-2.20,P<0.05)。术后3周、3个月及6个月双瓣缝合组吻合口直径均大于单瓣缝合组(Z=-4.10、-5.08、-4.62,均P<0.001),且术后6个月,双瓣缝合组大直径吻合口率高于单瓣缝合组(Z=-4.49,P<0.001)。双瓣缝合组手术有效率为95.96%(95/99),高于单瓣缝合组的81.63%(80/98)(Z=-4.22,P<0.001)。两组并发症发生率比较差异无统计学意义(P=1.000),并发症主要为吻合口周围肉芽组织增生、泪小管豁裂及中鼻甲黏膜与鼻腔外侧壁黏膜粘连。结论与单瓣缝合相比,双瓣缝合在临床效果上改善患者溢泪症状更快,早期吻合口上皮化优良率更高,更容易获得大直径吻合口,手术有效率更高。

Objective To compare the clinical effects of double flap suturing and single flap suturing in endoscopic endonasal dacryocystorhinostomy.Methods This was a randomized controlled study.A total of 197 eyes of 197 patients who underwent endoscopic endonasal dacryocystorhinostomy from Jan.to Dec.2021 in the Aier Eye Hospital of Wuhan University were selected.The patients were divided into two groups based on random number table:99 patients in the double flap suturing group and 98 patients in the single flap suturing group.According to the grouping,double flap suture and single flap suture of lacrimal sac flap and nasal mucosa flap were performed respectively.The preoperative Munk score,intraoperative ostium diameter,postoperative Munk score,lacrimal irrigation test,functional endoscopic dye test(FEDT),ostium diameter,degree of ostium epithelization and complications were recorded and compared.The follow-up time was 6 months after surgery.Results The Munk scores of the two groups at 6 months after operation were lower than those before operation(Z=-7.85,-8.99;all P<0.001).The Munk score of the double flap suturing group was lower than that of the single flap suturing group at 3 weeks after operation(Z=-3.64,P<0.001).The excellent and good rate of ostium epithelization in the double flap suturing group was 94.95%(94/99),which was higher than the 86.73%(85/98)in the single flap suturing group(Z=-2.20,P<0.05).The ostium diameter of the double flap suturing group was larger than that of the single flap suturing group at 3 weeks,3 and 6 months after operation(Z=-4.10,-5.08,-4.62;all P<0.001),and the rate of large ostium diameter in the double flap suturing group was higher than that in the single flap suturing group at 6 months after operation(Z=-4.49,P<0.001).The clinical effect rate of the double flap suturing group was 95.96%(95/99),higher than the 81.63%(80/98)of the single flap suturing group(Z=-4.22,P<0.001).There was no significant difference in the incidence of complications between the two groups(P=1.000).The main complications were hyperplasia of granulation tissue around the ostium,laceration of lacrimal canaliculus,and nasal synechiae formation between lateral wall of nose and middle turbinate.Conclusion Compared with single flap suturing,the clinical efficiency of double flap suturing is higher.It improves the clinical effect for patients with epiphora faster.And also the excellent and good rate of early ostium epithelization is higher,and it is easier to obtain large diameter ostium.