医用自交联透明质酸钠凝胶对慢性泪囊炎鼻内镜下泪囊鼻腔吻合术效果观察

Effect of medical self-crosslinking sodium hyaluronate gel on dacryocystorhinostomy under nasal endoscope for chronic dacryocystitis

目的 探究医用自交联透明质酸钠凝胶对慢性泪囊炎鼻内镜下泪囊鼻腔吻合术(En-DCR)患者吻合口黏膜上皮愈合及渗血情况的影响。方法 选取2018-01-06-2022-01-15安阳市眼科医院治疗的86例慢性泪囊炎患者作为研究对象,均进行En-DCR。术后依照填充物不同分为眼膏组和凝胶组,眼膏组43例用妥布霉素地塞米松眼膏填充吻合口创面,凝胶组43例用医用自交联透明质酸钠凝胶填充吻合口,对比2组治愈及有效情况、吻合口黏膜上皮愈合情况、渗血情况和并发症发生情况。结果 凝胶组治愈32例,好转9例,无效2例,眼膏组治愈24例,好转11例,无效8例。凝胶组治愈率为74.42%(32/43),与眼膏组55.81%(24/43)比较,差异无统计学意义,χ^(2)=3.276,P=0.070;凝胶组治疗有效率为95.35%(41/43),高于眼膏组的81.40%(35/43),差异有统计学意义,χ^(2)=4.074,P=0.044。凝胶组术后2周吻合口黏膜上皮愈合率为81.40%(35/43),高于眼膏组的44.19%(19/43),χ^(2)=12.741,P<0.001;术后1个月吻合口黏膜上皮愈合率为93.02%(40/43),高于眼膏组的76.74%(33/43),χ^(2)=4.441,P=0.035。凝胶组0、Ⅰ、Ⅱ、Ⅲ级渗血率分别为72.09%、20.93%、6.98%和0,优于眼膏组的95.35%、4.65%、0和0,差异有统计学意义,Z=2.930,P=0.002。眼膏组瘢痕增生1例,吻合口粘连2例,凝胶组吻合口粘连1例,2组并发症发生率比较差异无统计学意义,P=0.616。结论 医用自交联透明质酸钠凝胶可改善慢性泪囊炎En-DCR术患者渗血情况,调节吻合口黏膜上皮愈合,改善治愈及有效情况,提高临床安全性。

Objective To investigate the effect of medical self-crosslinking sodium hyaluronate gel on mucosal healing and blood oozing of anastomotic mucosa in patients with chronic dacryocystitis undergoing endoscopic dacryocystisinostomy(En-DCR).Methods A total of 86patients with chronic dacryocystitis from Anyang Eye Hospital from January 6,2018 to January 15,2022were selected as research objects and divided into eye paste group and gel group according to different fillers.Both groups were treated with En-DCR.Fourty-three patients in the eye paste group were treated with tobramycin and dexamethasone eye paste to fill the anastomotic wound after surgery,while 43patients in the gel group were treated with medical self-crosslinking sodium hyaluronate gel to fill the anastomotic wound.The healing and effectiveness,muco-sal epithelial healing of the anastomosis,blood infiltration,and the occurrence of complications were compared between the two groups.Results In the gel group,32cases were cured,9cases improved,and 2cases failed.In the eye paste group,24cases were cured,11cases improved,and 8cases failed.The cure rate of the gel group was 74.42%(32/43),which was not statistically significant compared with 55.81%(24/43)of the eye paste group,χ^(2)=3.276,P=0.070.The effective rate of treatment in the gel group was 95.35%(41/43),higher than 81.40%(35/43)in the eye paste group,with a statistically significant difference,χ^(2)=4.074,P=0.044.In the gel group,the healing rate of mucosa epi-thelium at the anastomosis was 81.40%(35/43),higher than 44.19%(19/43)in the eye paste group two weeks after surgery,χ^(2)=12.741,P<0.001.The healing rate of the anastomotic mucosal epithelium at one month after surgery was 93.02%(40/43),which was higher than 76.74%(33/43)in the eye paste group,χ^(2)=4.441,P=0.035.The bleeding rates of grade 0,Ⅰ,ⅡandⅢin the gel group were 72.09%,20.93%,6.98%and 0respectively,which were better than 95.35%,4.65%,0and 0in the eye paste group,with a statistically significant difference(Z=2.930,P=0.002).There was 1case of scar hyperplasia,2cases of anastomotic adhesion in the eye paste group,and 1case of anastomotic adhesion in the gel group.There was no significant difference in the incidence of complications between the two groups,P=0.616.Conclusion Medical self-crosslinking sodium hyaluronate gel can improve blood infiltration in patients under-going En-DCR for chronic dacryocystitis,regulate anastomotic mucosal epithelial healing,improve cure and effectiveness,and improve clinical safety.