先天性鼻泪管阻塞的鼻内镜手术方式选择及疗效观察  

Selection and efficacy of endoscopic nasal surgery for congenital nasolacrimal duct obstruction

作　　者：陈荣新[1] 李静[1] 于欣悦 胡玉 孟子葳 曹淑娟 艾则孜·吾买尔 姜爱新 谢玲玲[2] 梁轩伟[1] Chen Rong-xin;Li Jing;Yu Xin-yue(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China.)

机构地区：[1]中山大学中山眼科中心,眼科学国家重点实验室,广东省眼科视觉科学重点实验室,广东省眼部疾病临床医学研究中心,510060 [2]中山大学附属喀什医院,喀什地区第一人民医院

出　　处：《中国斜视与小儿眼科杂志》2022年第2期1-6,I0011,共7页Chinese Journal of Strabismus & Pediatric Ophthalmology

基　　金：广东省自然科学基金项目(2021A1515012043);广东省农村科技特派员项目(KTPYJ2021021);眼科学国家重点实验室专项经费(30306020240020219);喀什地区第一人民医院“珠江学者·天山英才”合作专家工作室创新团队(KDYY202018);新疆维吾尔自治区创新环境(人才、基地)建设专项(天山青年计划)(2019Q145)。

摘　　要：目的分析鼻内镜下手术治疗先天性鼻泪管阻塞(CNLDO)的个体化选择,并评估其有效性和安全性。方法回顾性分析2019年1月至2021年8月在中山大学中山眼科中心就诊的年龄小于12岁的CNLDO病例,所有患儿保守治疗无效且至少进行过一次失败的泪道探通治疗,根据术前术侧泪道CT影像特征以及术中泪道探针探查选择鼻内镜下的手术方式,包括鼻内镜下Hasner瓣膜切开成形术、鼻内镜下泪囊鼻腔吻合术(EnDCR)。术后1个月后经鼻内镜评估开口或吻合口,通过门诊或电话随访评估主观症状改善情况,并记录并发症情况。手术成功被定义为泪道冲洗通畅,且症状完全缓解或明显改善。结果共有38例(47眼)CNLDO,其中,38.3%(18/47眼)病例接受鼻内镜下Hasner瓣膜切开成形术,61.7%(29/47眼)接受了En-DCR。鼻泪管阻塞部位与鼻内镜下手术方式的选择显著相关(P<0.001),骨性鼻泪管结构异常与鼻内镜下手术方式的选择显著相关(P=0.044)。38名患儿(47眼)的手术成功率100%,未见脑脊液漏、眼眶穿透、大量出血、感染扩散、泪道置管脱出等并发症。结论鼻内镜下Hasner瓣膜切开成形术或En-DCR对治疗CNLDO具有确切的疗效和安全性,但应根据鼻泪管阻塞部位、骨性鼻泪管结构,个体化选择鼻内镜下手术方式。Objective Analyze the individualized selection of surgical treatment of congenital nasolacrimal duct obstruction(CNLDO)under nasal endoscopy,and evaluate its effectiveness and safety.Methods A retrospective analysis of CNLDO cases younger than 12 years old in the Zhongshan Ophthalmic Center,Sun Yat-sen University from January 2019 to August 2021.All children have failed conservative treatment and have undergone at least one failed lacrimal passage probing treatment.According to the preoperative side lacrimal duct CT image characteristics and intraoperative lacrimal duct probe exploration to select the surgical method under nasal endoscopy,including endoscopic hasner valvuloplasty or endoscopic dacryocystorhinostomy(En-DCR).One month after the operation,the opening or anastomosis was assessed by nasal endoscopy,the improvement of subjective symptoms was assessed through outpatient or telephone follow-up,and complications were recorded.The success of the operation is defined as the lacrimal duct flushing is unobstructed,and the symptoms are completely relieved or significantly relieved.Results A total of 38 cases(47 eyes)of CNLDO,38.3%(18/47 eyes)of CNLDO received endoscopic Hasner valvuloplasty,61.7%(29/47 eyes)of CNLDO received En-DCR.The location of nasolacrimal duct obstruction was significantly related to the choice of endoscopic nasal surgery(P<0.001),and the structural abnormality of the bony nasolacrimal duct was significantly related to the choice of nasal endoscopic surgery(P=0.044).The operation success rate of 38 children(47 eyes)was 100%,and there were no complications such as leakage of cerebrospinal fluid,orbital penetration,massive hemorrhage,spread of infection,and prolapse of the lacrimal duct.Conclusions Endoscopic Hasner valvuloplasty or En-DCR has a definite effect and safety on the treatment of CNLDO,but the method of nasal endoscopic surgery should be individualized according to the location of the nasolacrimal duct obstruction and the structure of the bony nasolacrimal duct.

关 键 词：鼻内镜 先天性鼻泪管阻塞 Hasner瓣膜切开成形术 泪囊鼻腔吻合术 个体化手术 

分 类 号：R779.6[医药卫生—眼科]