鼻内镜下泪囊鼻腔吻合术联合应用纳吸绵治疗慢性泪囊炎

摘要

目的 评价鼻内镜下泪囊鼻腔吻合术(En-DCR)联合应用纳吸绵(Nasopore)治疗慢性泪囊炎的临床疗效.方法 采用临床随机对照研究.慢性泪囊炎90例(96只眼)随机分成两组:纳吸绵组和支架组各48只眼.两组均行En-DCR,纳吸绵组应用纳吸绵置入吻合口,支架组应用泪囊鼻腔引流支架(NLDS)支撑吻合口.术后随访6个月,比较两组手术成功率,吻合口愈合情况及肉芽、瘢痕组织形成情况.结果 最终完成随访者84例(90只眼),纳吸绵组41例(45只眼)和支架组43例(45只眼).随访至术后6个月,纳吸绵组手术成功率97.8%(44/45)高于支架组88.9%(40/45),吻合口肉芽组织形成率6.7%(3/45)低于对照组24.4%(11/45),瘢痕组织形成率8.9%(4/45)低于28.9%(13/45).结论 En-DCR联合纳吸绵应用能够减少肉芽组织和瘢痕组织形成,提高手术成功率,亦减少鼻内镜下随访换药次数,简便高效.%Objective To evaluate the efficacy of endoscopic dacryocystorhinostomy(En-DCR) combined with Nasopore in the treatment for chronic dacryocystitis.Methods A total of 90 cases(96 eyes) were divided into two groups at random: Nasopore group and stent group with 48 eyes in each group.All patients of two groups underwent En-DCR.Nasopore were implanted in the anastomosis of Nasopore group, and patients in stent group received combined NLDS implantation.Patients were followed up after postoperation for 6 months.The surgical success rates of En-DCR,The conditions of anastomotic stoma , occurrence of granulation tissue and the proliferation of scar tissue were observed and compared between two groups.Results 84 patients (90 eyes) were ultimately observed, including 41 cases(45 eyes) in Nasopore group and 43 cases(45 eyes) in stent group.The surgical success rate of in Nasopore group was 97.8%(44/45), which was higher than that of 88.9%(40/45)in the stent group;Granulation formation rate at the ostium margins of the Nasopore group was6.7%(3/45),which was lower than that of 24.4%(11/45)in the stent group scarring formation rate of the Nasopore group was 8.9%(4/45), which was lower than that of 28.9%(13/45)in the stent group.Conclusion En-DCR combined with Nasopore implantation reduces the formation of granulation and scar tissue, thus improves primary success rate of En-DCR and reduces the reprocessing frequency under endoscope.So it is a simple and more efficient operative way.