内窥镜下经鼻径路泪囊切开术在上泪道远端异物取出中的应用

Application of Endoscopic Transnasal Dacryocystorhinostomy in Removal of Foreign Bodies in the Distal Part of Upper Lacrimal Duct

目的::探讨内窥镜下经鼻径路泪囊切开术进行上泪道远端异物取出并重建泪液引流的可行性。方法::回顾性临床研究。连续收集2008年5月至2021年10月期间就诊于温州医科大学附属眼视光医院,且采取内窥镜下经鼻径路泪囊切开术进行上泪道远端异物取出的患者17例(17眼)进行分析。分析异物是否取出、异物种类、术后泪液引流重建的成功率及手术并发症。结果::患者年龄21~60(38.5±12.2)岁,其中右眼7眼,左眼10眼,病程2~65(21.5±4.8)d。所有异物均顺利取出,其中圆形金属异物7眼,破碎小硅胶异物5眼,断裂猪鬃毛4眼,断裂探针小金属1眼。术后随访12~24(16.1±3.8)个月,所有患者均未诉溢泪、溢脓,泪道冲洗通畅,且未见明显上泪道狭窄或阻塞、泪囊鼻腔吻合口闭锁、鼻部不适等并发症。结论::内窥镜下经鼻径路泪囊切开术为上泪道远端异物取出的一种可行方法,值得临床推广。

Objective:To investigate the viability of removing foreign bodies located in the distal part of the upper lacrimal duct and meanwhile restoring the normal flow of tear drainage.Methods:From May 2008 to October 2021,a retrospective analysis was conducted in 17 patients(17 eyes)who underwent endoscopic transnasal dacryocystorhinostomy for the removal of foreign bodies in the distal part of the upper lacrimal duct at Eye Hospital,Wenzhou Medical University.Surgical outcomes were recorded,including whether the foreign bodies were removed,the type of foreign bodies,the success rate of tear drainage reconstruction,and surgical complications.Results:A total of 17 cases(7 right and 10 left eyes)with an average age of 38.5±12.2 years(ranging from 21 to 60 years)and a duration of symptoms of 21.5±4.8 days(ranging from 2 to 65 days).All surgeries were successfully completed without any complications,and all foreign bodies were successfully removed.The types of foreign body removed included circular metal foreign bodies in 7 eyes,broken small silicone tips in 5 eyes,broken pig bristles in 4 eyes,and broken probe small metal in 1 eyes.The postoperative follow-up period ranged from 12 to 24 months,with a mean of 16.1±3.8 months.At the final review,none of the patients complained of tearing or pus discharge,and all had normal tear drainage by lacrimal irrigation.There were no obvious complications observed,such as stenosis or obstruction of the upper lacrimal duct,atresia of dacryocystonasal anastomosis,or any nasal disorders.Conclusions:Endoscopic transnasal dacryocystorhinostomy appears to be a viable method to remove foreign bodies located in the distal part of upper lacrimal duct,and it is recommended for clinical use.