微瓣缝合法在鼻内镜下泪囊鼻腔吻合术中的应用

Application of microflap anastomosis technique in endoscopic endonasal dacryocystorhinostomy

目的 观察和分析微瓣缝合法在鼻内镜下泪囊鼻腔吻合术中的应用效果。方法 对2016年4月—2022年1月我院收治的15例慢性泪囊炎患者行鼻内镜下泪囊鼻腔吻合术,术中均采用微瓣缝合法固定泪囊瓣与鼻黏膜瓣,术后随访4个月观察其疗效。采用Munk评分对比患者术前、术后溢泪程度,鼻内镜检查及泪道冲洗评估术后吻合口通畅情况。结果 溢泪Munk评分由术前(4.00±1.00)分降至术后4个月的(0.07±0.26)分(t=15.849,P <0.05)。鼻内镜下见15眼泪囊吻合口通畅且上皮化良好,泪道冲洗通畅。1例患者合并泪小点狭窄,术后仍有轻度溢泪,其余均治愈。结论 鼻内镜下泪囊鼻腔吻合术中运用微瓣缝合法可有效固定泪囊瓣,防止其回缩后造成吻合口狭窄或闭锁,可明显改善慢性泪囊炎患者溢泪、溢脓等症状,疗效可靠。

Objective To evaluate the clinical outcomes of microflap anastomosis technique in endoscopic endonasal dacryocystorhinostomy in patients with chronic dacryocystitis.Methods A prospective study was performed in 15 adult cases of chronic dacryocystitis with endonasal surgery.The clinical outcomes of microflap anastomosis by fixating dacryocyst flap with nasal mucosa flap were examined during endoscopic endonasal dacryocystorhinostomy.Before surgery and 4 months after surgery,the Munk score was used to evaluate dacryorrhea for each patient.Obstruction of anastomosis was examined using endoscopic inspection and lacrimal irrigation.Results After endonasal surgery,the Munk score was significantly decreased from 4.00±1.00(pre-operation)to 0.07±0.26(post-operation).All patients showed well anastomosis with open dacryocystorhinostomy under endoscopic inspection and lacrimal irrigation.One case developed lacrimal stenosis and slight dacryorrhea.The other 14 cases were all cured.Conclusion The microflap anastomosis technique in endoscopic endonasal dacryocystorhinostomy is useful for the well anastomosis with open dacryocystorhinostomy by fixating dacryocyst flap with nasal mucosa flap for patients with chronic dacryocystitis.