不同浓度丝裂霉素在泪囊鼻腔吻合术后复发应用对比观察  

Clinical observation of different mitomycin C concentration in lacrimal duct plasty by laser of recurrent obstruction after dacryocystorhinostomy

作　　者：朱兆春[1] 王玉[2] 胡尊霞[1] 宋娜[1] 何丽[1] 王合刚 李镜海[1] 

机构地区：[1]济南爱尔眼科医院,山东250100 [2]济南市第二人民医院眼科,山东250100

出　　处：《中国实用眼科杂志》2014年第8期980-983,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 评价注射用丝裂霉素C （MMC）在泪囊鼻腔吻合术后复发临床效果以及丝裂霉素不同浓度之间的疗效对比.方法 临床病例对照研究.将2010年2月至2013年1月在济南市爱尔眼科医院就诊的72例（74只眼）单纯慢性泪囊炎行鼻内镜下泪囊鼻腔吻合手术后复发患者,按入院先后顺序随机分为MMC观察组（56只眼）和对照组（18只眼）.其中：MMC观察组按计量不同,再分为应用0.2 mg/ml丝裂霉素C18只眼、应用0.5 mg/ml丝裂霉素C19只眼和应用1 mg/ml丝裂霉素C19只眼,计三组,并于应用泪道激光打通闭塞孔后联合不同浓度的MMC浸润5 min后放置泪道引流管1个月;对照组18只眼,应用泪道激光打通后单纯放置泪道引流管1个月.随访6～10个月,观察其临床疗效,记录患者泪溢情况、肉芽形成后消失情况、下睑缘角膜间泪液弧高度以及泪道冲洗情况,并作统计分析.结果 MMC组浓度为0.2 mg/ml有14只眼吻合口形成良好,浓度为0.5 mg/ml有17只眼吻合口形成良好,浓度为1 mg/ml有19只眼吻合口形成良好;0.2 mg/ml与1 mg/ml之间有差异,0.2 mg/ml和0.5mg/ml两者之间随着作用时间的延长,其吻合口处肉芽组织和膜闭的形成有减少趋势.其泪溢症状改善有效率为MMC观察组94.43％ （54/56）明显高于对照组66.67％ （12/18）,差异比较有统计学意义（x2=9.617,P=0.002）.结论 MMC作为抗代谢类药物对肉芽组织和纤维组织增生有明显的抑制作用,而且随着MMC浓度的升高,其吻合口处肉芽组织的形成、吻合口的膜闭明显减少.Objective To compare the efficacy of different mitomycin C （MMC） concentration injection in recurrent obstruction after dacryocystorhinostomy.Methods A randomized controlled clinical study,74 eyes （72 patients） of recurrent obstruction after endoscopic dacryocystorhinostomy because of simple chronic dacryocystitis were divided into study group and control group from February 2010 to January 2013.The study group was divided into 3 sub-groups according to different MMC concentration,18 eyes applied by 0.2mg/ml MMC,19 eyes applied by 0.5mg/ml MMC,19eyes applied by 1.0mg/ml MMC.MMC was used at the hole for 5 minutes after the obstruction had been knocked through by laser.Lacrimal drainage tube was placed in the hole for 1 month.Eighteen eyes were enrolled in the control group and did not use MMC before placing the lacrimal drainage tube.The observation and statistical analysis include Epiphora,granulation tissue,the height of lacrimal river and patency of lacrimal.Results The anastomotic formed in 14 eyes in 0.2mg/ml MMC group and 17 eyes in 0.5mg/ml MMC group and 19 eyes in 1.0mg/ml MMC group.There was statistical difference between 0.2mg/ml MMC group and 1.0mg/ml MMC group.The granulation tissue and formation of membrane at the anastomotic decreased gradually with time.In control group,symptom of epiphora disappeared in 4 eyes,and 2 eyes relieved,but 3 eyes had no change.There was statistical difference between study group and control group.Conclusions MMC has significantly inhibitory action on proliferation of granulation tissue and fibrous tissue as an antimetabolite drug.The decrease of granulation tissue and formation of membrane at the anastomotic are related with the increase concentration of MMC.

关 键 词：复发性泪囊炎 鼻内窥镜 丝裂霉素C 

分 类 号：R777.230.5[医药卫生—眼科]