鼻内镜下高位泪囊鼻腔吻合术28例报告  被引量:6

High-position Dacryocystorhinostomy Under Nasal Endoscope:Report of 28 Cases

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作  者:黄诗恩 徐景利 张钦[3] 王旻[1] 吕志刚 史慕寒 李辉[1] 吴雨潇 Huang Shien;Xu Jingli;Zhang Qin(Department of Otolaryngology, Peking University People’s Hospital, Beijing 100044, China)

机构地区:[1]北京大学人民医院耳鼻咽喉科,北京100044 [2]北京中医医院顺义医院耳鼻咽喉科,北京101300 [3]北京大学人民医院眼科,北京100044 [4]内蒙古兴安盟人民医院耳鼻咽喉科,乌兰浩特137400

出  处:《中国微创外科杂志》2021年第4期356-361,共6页Chinese Journal of Minimally Invasive Surgery

基  金:首都卫生发展科研专项基金(2020-1-2051);北京大学医学交叉研究种子基金(BMU2018MX003)。

摘  要:目的探讨鼻内镜下高位泪囊鼻腔吻合术(dacryocystorhinostomy,DCR)治疗单纯性慢性泪囊炎的临床疗效。方法2016年2月~2019年6月我院采用高位DCR治疗28例(32眼)慢性泪囊炎,术中通过定位泪囊于中鼻甲腋上方8 mm,咬除上颌骨额突,暴露Rosenmüller瓣膜以充分暴露泪囊,制备黏膜瓣以减少术后吻合口狭窄机会。术后采用Munk评分评估患者主观溢泪情况,泪道冲洗及鼻内镜下观察以评估吻合口通畅情况,综合评估手术疗效及随访患者的满意度。结果术中均可顺利定位泪囊,27例(31眼)切开泪囊后可明确暴露Rosenmüller瓣,其中1例(1眼)经二次手术后才可暴露Rosenmüller瓣。28例术后随访9~48个月,中位数22个月。溢泪Munk评分中位数由术前4分(2~5分)降至术后1个月0分(0~3分)(Z=-4.987,P=0.000)和术后3个月0分(0~3分)(Z=-4.998,P=0.000);术后3个月后吻合口逐渐稳定,术后1个月与术后3个月Munk评分无明显变化(Z=-0.850,P=0.395)。鼻内镜下见96.9%(31/32)患眼泪囊吻合口通畅且上皮化良好,泪道冲洗通畅。患者对手术效果满意度评分5分占92.9%(26/28)。结论高位DCR通过准确定位泪囊、暴露Rosenmüller瓣膜,明显改善单纯性慢性泪囊炎患者的溢泪情况,具有明显的临床疗效。Objective To investigate the clinical efficacy under nasal endoscopic high-position dacryocystorhinostomy(DCR)in patients with simple chronic dacryocystitis.Methods We retrospectively analyzed 28 patients(32 eyes)with chronic dacryocystitis who underwent high-position DCR in our hospital from February 2016 to June 2019.During the operation,we located the lacrimal sac 8 mm above the axilla of the middle turbinate,removed the frontal process of the maxilla,exposed the the Rosenmüller valves to fully expose the lacrimal sac and made the mucosal flaps to reduce the chance of stenosis.After operation,we evaluated the surgical effect according to the Munk score and observed the new ostium through lacrimal passage irrigation under endonasal endoscope.Results The lacrimal sac was located successfully in all the cases.The Rosenmüller flaps were clearly exposed after lacrimal sac incision in 27 cases(31 eyes),and were exposed in 1 case(1 eye)after the second operation.The 28 cases were followed up for 9-48 months(median,22 months).The median postoperative Munk score decreased significantly from 4(2-5)points before operation to 0(0-3)points at 1 month after operation(Z=-4.987,P=0.000)and 0(0-3)points at 3 months after operation(Z=-4.998,P=0.000).The anastomosis became stable gradually at 3 months after operation.There was no significant difference in Munk score between 1 month and 3 months after operation(Z=-0.850,P=0.395).The lacrimal sac anastomosis was unobstructed and epithelialized in 96.9%(31/32)under nasal endoscope with passable lacrimal passage irrigation.Patients’satisfaction with the operation was 5 points,accounting for 92.9%(26/28).Conclusion By accurately locating the lacrimal sac and exposing the Rosenmüller valves,high-position DCR can significantly improve epiphora in patients with simple chronic dacryocystitis.

关 键 词:泪囊鼻腔吻合术 慢性泪囊炎 Munk评分 泪道泵 

分 类 号:R779.6[医药卫生—眼科]

 

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