鼻黏膜瓣留置对内窥镜下泪囊鼻腔吻合术的疗效影响  

Influence of nasal mucosal flaps preservation on endonasal endoscopical dacryocystorhinostomy

作　　者：季青山[1] 钟敬祥[1] 劳苇[1] 涂云海[2] 吴文灿[2] 

机构地区：[1]暨南大学附属第一医院眼科,广东省广州市510632 [2]温州医学院附属眼视光医院,浙江省温州市325027

出　　处：《眼科新进展》2013年第8期751-754,共4页Recent Advances in Ophthalmology

基　　金：广东省自然科学基金资助(编号:S2011010004186)~~

摘　　要：目的观察鼻黏膜瓣留置对慢性泪囊炎内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryoc ystorhinostomy,EES-DCR)疗效的影响。方法采用临床随机对照研究。选取160例(160眼)慢性泪囊炎患者随机分成两组:EES-DCR联合鼻黏膜瓣留置组(A组)和EES-DCR祛除鼻黏膜瓣组(B组),每组各80例(80眼)。术后随访12个月,比较两组患者手术成功率、肉芽组织和瘢痕组织形成情况。结果本研究最终完成随访资料149例,其中A组73例、B组76例纳入分析。A组手术成功率97.3%(71/73)高于B组82.9%(63/76)。在随访期间;;A组有19.2%(14/73)、B组42.1%(32/76)患者吻合口周围发生肉芽组织增生(P<0.05)。术后随访12个月;;A组有7例、B组20例患者有明显瘢痕组织形成(P<0.05)。A组有2例因肉芽组织增生、B组有13例因肉芽组织和/或瘢痕组织增生阻塞造瘘口引起手术失败。结论 EES-DCR联合鼻黏膜瓣留置减少肉芽组织和瘢痕组织形成;;提高EES-DCR手术成功率。Objective To investigate the influence of nasal mucosal flaps preser- vation on endoscopic endonasal dacryocystorhinostomy（EES-DCR） on the treatment of chronic dacryocystitis. Methods It was a clinically randomized controlled trial. One hundred and sixty patients with chronic dacryocystitis were randomly collected and e- venly divided into two groups：EES-DCR with nasal mucosal flaps group （group A） and EES-DCR without nasal mucosal flaps group （group B）. Patients were followed up for 12 months. The success rates of EES-DCR, occurrence of granulation tissue and the pro- liferation of scar tissue were compared in two groups. Results This study included complete postoperative datas of 149 patients, of which 73 patients in group A and 75 pa- tients in group B. The success rate of group A（97.3% ,71/73 ） was higher than that in group B（ 82.9% , 53/75）. During process of following up, the occurrence of granulation tissue at the ostium margins accounted for 19.2% （ 14/73 ） in group A and 42.1% （32/ 76） in group B（P 〈 0.05 ）. They were followed up for 12 months, and scar tissue ap- peared in 7 patients in group A compared with 20 patients in group B （P 〈 0.05 ）. In group A,2 patients failed because of excessive formation of granulation tissue. In group B, 13 patients had failed because of excessive formation of granulation or/and scar tis- sue around the intranasal ostium. Conclusion EES-DCR combined with nasal muco- sal flaps technique reduces the formation of granulation and scar tissue, which improves the success rate of EES-DCR.

关 键 词：慢性泪囊炎 内窥镜下泪囊鼻腔吻合术 黏膜瓣 

分 类 号：R777.23[医药卫生—眼科]