鼻内镜下泪囊鼻腔吻合术治疗泪道阻塞性疾病的疗效及安全性分析

Analysis of the efficacy and safety of dacryocystosinostomy under nasal endoscope in the treatment of lacrimal duct obstruction

目的探讨鼻内镜下泪囊鼻腔吻合术治疗泪道阻塞性疾病的疗效及安全性。方法选取2019年3月至2022年6月湖州市第一人民医院收治的泪道阻塞患者50例,采用随机数字表法分为观察组和对照组,每组25例。观察组采用鼻内镜泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy,En-DCR)治疗,对照组采用传统的经内眦外路泪囊鼻腔吻合术(externaldacryocystorhinostomy,Ex-DCR)治疗,所有患者均随访6个月,比较两组的手术相关指标、临床疗效、术后并发症发生情况及复发率。结果观察组手术时间和住院时间短于对照组,术中出血量少于对照组,术后疼痛视觉模拟量表(visual analogue scale,VAS)评分低于对照组,差异均有显著性(P<0.05)。术后1个月时观察组的治疗总有效率(100%)与对照组(92%)比较差异无显著性(P>0.05),而术后6个月时观察组的治疗总有效率(100%)明显高于对照组(84%),差异有显著性(P<0.05)。观察组术后并发症发生率(4%)明显低于对照组(24%),差异有显著性(P<0.05),而两组复发率比较差异无显著性(P>0.05)。结论与传统的Ex-DCR相比,En-DCR治疗泪道阻塞性疾病具有创伤小、疗效佳、术后并发症少的优点,患者更容易耐受。

Objective To investigate the efficacy and safety of dacryocystosinostomy under nasal endoscope in the treatment of lacrimal duct obstruction.Method Fifty patients with lacrimal duct obstruction were selected and received treatment in our hospital from March 2019 to June 2022.The 50 patients were randomly divided into observation group and control group.The observation group was treated with endoscopic dacryocystorhinostomy(En-DCR).The control group was treated with the traditional external dacryocystorhinostomy(Ex-DCR)through the inner canthus skin path.The length of operation,the amount of bleeding,the length of hospital stay,the degree of pain,the clinical efficacy,the occurrence of postoperative complications and the rate of postoperative recurrence were compared between the two groups.Result There was no significant difference in the general information of 50 patients(P<0.05).Operation duration,blood loss,length of hospital stay and visual analogue scale(VAS)of the observation group were better than the control group(P<0.05).After 1 month,the effective rate of the observation group(100%)was higher than that of the control group(92%),but the difference was not statistically significant(P>0.05).After 6 months,the effective rate of the observation group was 100%,the effective rate of the control group was 84%,and the effective rate of the observation group was significantly higher than that of the control group(P<0.05).Postoperative complication rate:The observation group had 1 case of nasal mucosal bleeding,the control group had 1 case of facial swelling,1 case of postoperative infection,4 cases of nasal mucosal bleeding,the complication rate of observation group(4%)was lower than that of control group(24%)(P<0.05).After 6 months,there was no recurrence in the observation group and 2 cases in the control group.The recurrence rate in the observation group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion Compared with traditional external DCR,En-DCR has the characteristics of less trauma,better efficacy and fewer postoperative complications,and it is easier for patients to tolerate.