不同浓度丝裂霉素C在泪囊鼻腔吻合术应用中的比较  

Different concentration of mytomycin C in dacryocystorhinostomy

作　　者：游逸安[1] 孙新成[1] 方春庭[1] 廖志苏[2] 

机构地区：[1]温州医学院附属第一医院眼科,325000 [2]温州医学院附属第一医院耳鼻喉科,325000

出　　处：《重庆医学》2007年第12期1157-1160,共4页Chongqing medicine

摘　　要：目的 探讨丝裂霉素C（MMC）在泪囊鼻腔吻合术（dacryocystorhinostomy，DCR）中不同浓度丝裂霉素C应用的疗效，为提高DCR手术的远期疗效寻找一种安全有效的辅助措施。方法 151例（164眼）泪道阻塞患者随机分为对照组和治疗组，对照组采用常规的DCR手术，而治疗组在常规DCR术中用分别含0．01％MMC（MMC1组）、0．02％MMC（MMC2组）、0．05％MMC（MMC3组）的棉片置骨切孔区鼻黏膜和泪囊黏膜上5min。结果术后随访3～84个月，平均（57．7±1．07）个月，对照组44眼中34眼（77．27％）泪道冲洗通畅，MMC1组36眼中30眼（83．33％）泪道冲洗通畅；MMC2组48眼中46眼（95．83％）泪道冲洗通畅。MMC3组35眼中32眼（91．43％）泪道冲洗通畅。经手术3年后，Kaplan—Meier生存曲线显示对照组与治疗组总体上差异有统计学意义（χ^2=5．78。P=0．0162，log—rank test）。但MMC1组与对照组差异无统计学意义（χ^2=0．50，P=0．4783，log-rank test）。MMC2与MMC3差异无统计学意义（χ^2=0．81，P=0．3679。log—rank test）。无手术并发症。术后吻合口大小观察，MMC治疗组吻合口〉对照组，0．02％MMC、0．05％MMC组〉0．01％MMC组。结论 在DCR手术中应用MMC是一种能提高远期疗效的安全有效的辅助措施。0．02％较0．05％MMC更具安全性。Objective To assess the efficacy of different concentration mitomycin C （MMC） in dacryosystorhinostomy （DCR） and to find out an effective adjuvant method for improving the long-term operative effect for DCR. Methods One hundred and fifty- one cases （164 eyes） with chronic dacryocystitis were randomized to either mitomycin C group or control group. In the control group, the simple external DCR procedures were employed . Whereas in the MMC group, the surgical procedures were exactly the same except that a piece of cotton soaked with 0.01%MMC（MMC1 group）, 0.02%MMC（MMC2 group）, 0.05%MMC（MMC3 group） were applied to the nasal mucosa and the mucosa of lacrimal sac in osteotomy site for 5min. Results Lacrimal drainage systems for all patients in four groups were patent by irrigation and success rate was 100% 1 month postoperatively. With the mean follow-up of 3-84 months（57.7± 1.07 months） postoperatively, lacrimal drainage systems were patent in 30/36eyes （83.33 % ） in MMC1 group, 46/48 eyes （95.83%） in MMC2 group, 32/35eyes （91.43%） in MMC3 group and 34/44 eyes（77.27%）in control group. Kaplan Meier survival analysis showed there was a statistically significant difference between MMC groups and control group （ χ^2 = 5.78, P = 0.016 2, log-rank test）, but no statistically significant difference between MMC1 group and control group （χ^2=0.50 ,P=0. 478 3 ,log-rank test）, and no statistically significant difference between MMC2 group and MMC3 group （χ^2=0.81, P=0. 367 9,log-rank test）. The mean actual osteotomy sizes in MMC groups were larger than that in control group, and that in both MMC2 group and MMC3 group were larger than that in MMC1 group. No any operative complications were appeared. Conclusion Intraoperative MMC in DCR seems to be a safe and effective adjuvant procedure and can maintain long-term highly success rate. 0.02%MMC is better than 0.01 %MMC and 0.05 % MMC. Further studies are needed.

关 键 词：泪囊鼻腔吻合术 丝裂霉素C 

分 类 号：R779.6[医药卫生—眼科]