EN-DCR术中隧道式吻合法的疗效探讨  

Therapeutic Effect of Tunnel-type Anastomosis in EN-DCR

作　　者：张咏 陈琳[1] 李沙 ZHANG Yong;CHEN Lin;LI Sha(Wuhan Aier Eye Hospital,Hankou Hospital,Wuhan,Hubei Province,420000 China)

机构地区：[1]武汉爱尔眼科医院汉口医院

出　　处：《中外医疗》2019年第26期8-11,共4页China & Foreign Medical Treatment

摘　　要：目的探讨鼻内镜下鼻腔泪囊吻合术(EN-DCR)中隧道式吻合法的临床疗效。方法方便选取2015年12月—2016年12月在汉口爱尔眼科医院就诊的166例(176眼)慢性泪囊炎患者作为研究对象,随机分为两组,对照组83例(88眼),实验组83例(88眼)。对照组术中沿骨缘将泪囊切开,使黏膜瓣进行传统的翻转式吻合,实验组术中将泪囊做一“Y”型切口,使泪囊粘膜与周边鼻黏膜呈隧道式吻合。随访至术后6个月,分别在术后3周、3个月及6个月时行鼻内镜检查,观察患者术后泪囊造口生长情况,分析隧道式吻合法在EN-DCR术后的疗效。结果术后3周时两组病例无明显差异,术后3个月时发现对照组有9例(10眼)患者造口处出现肉芽组织,5例(5眼)患者出现造口闭锁,实验组有5例(5眼)患者造口处出现肉芽组织,1例(1眼)患者出现造口闭锁;术后6月时对照组有8例(8眼)出现不同程度的造口处肉芽形成及造口回缩呈细梭状,9例(9眼)患者出现造口闭锁,实验组有2例(2眼)患者出现造口闭锁,4例(4眼)患者出现造口处肉芽增生,其他造口均未见明显回缩,对比两组之间差异有统计学意义(χ^2=4.7515,P=0.029<0.05)。结论EN-DCR术中隧道式吻合法使泪囊造口向四周牵拉式生长,能有效的降低泪囊造口处肉芽组织的形成,同时能有效持久的控制造口的回缩及变形。Objective To investigate the clinical efficacy of tunnel anastomosis in nasal endoscopic dacryocystorhinostomy(EN-DCR).Methods Convenient select a total of 166 patients(176 eyes)with chronic dacryocystitis who were admitted to Hankou Aier Eye Hospital from December 2015 to December 2016 were randomly divided into two groups:83 patients(88 eyes)in the control group.83 patients(88 eyes)in the experimental group.In the control group,the lacrimal sac was cut along the bone margin,and the mucosal flap was traditionally inverted.The experimental group was treated with a“Y”incision to make the lacrimal sac mucosa and the surrounding nasal mucosa tunnel-matched.Endoscopic examination was performed at 3 weeks,3 months,and 6 months after surgery to observe the growth of the lacrimal sac in the postoperative period.The tunnel anastomosis in EN-DCR effect was analyzed.Results There was no significant difference between the two groups at 3 weeks after operation.At 3 month affer operation In the control group,9 cases(10 eyes)showed granulation tissue at the stoma,and 5 patients(5 eyes)had stoma occlusion.There were 5 cases(5 eyes)with granulation tissue at the stoma,and 1 case(1 eye)with stoma occlusion.At 6 months after operation,8 cases(8 eyes)in the control group showed different degrees of granulation at the stoma.And the stoma retracted in a fine fusiform shape,9 patients(9 eyes)had stoma occlusion,2 patients(2 eyes)in the experimental group had stoma occlusion,and 4 patients(4 eyes)had granulation at the stoma.There was no significant retraction in other stomas,and the difference between the two groups was statistically significant(χ^2=4.751 5,P=0.02 9<0.05).Conclusion The tunnel-type anastomosis method in EN-DCR can cause the lacrimal sac to grow around the sac,which can effectively reduce the formation of granulation tissue at the lacrimal ostomy,and can effectively control the retraction and deformation of the stoma.

关 键 词：EN-DCR 隧道式吻合法 泪囊造口 牵拉式生长 

分 类 号：R735[医药卫生—肿瘤]