鼻内镜下泪囊鼻腔吻合术后新型吸切器切除吻合口肉芽组织的疗效  

Outcome of excision of ostium granulation tissues by a novel suction-cutting instrument post endoscopic endonasal dacryocystorhinostomy

作　　者：孙佳颖 刘珍凯 吴文灿 余波 Jia-ying Sun;Zhen-kai Liu;Wen-canWu;Bo Yu(Department of Ophthalmology,Chinese PLA General Hospital,Beijing 100853,China;Department of Ophthalmology,Shiyan Renmin Hospital,People's Hospital Affiliated to Hubei University of Medicine,Shiyan,Hubei 442000,China;Department of Orbital and Oculoplastic Surgery,Eye Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325027,China)

机构地区：[1]解放军总医院眼科,北京100853 [2]湖北医药学院附属人民医院(十堰市人民医院)眼科,湖北十堰442000 [3]温州医科大学附属眼视光医院眼眶及眼整形科,浙江温州325027

出　　处：《中国内镜杂志》2022年第10期36-41,共6页China Journal of Endoscopy

基　　金：温州市科技局科研项目(No:Y2020362)。

摘　　要：目的 评估鼻内镜下泪囊鼻腔吻合术(En-DCR)后用新型吸切器切除吻合口肉芽组织的效果。方法 招募2017年1月-2020年3月就诊于温州医科大学附属眼视光医院的原发性获得性鼻泪管阻塞(PANDO)患者进行En-DCR手术,术后主要通过内镜检查随访,评估吻合口愈合情况以及周围是否存在肉芽组织,将因肉芽组织影响泪液引流功能的病例纳入研究,根据肉芽组织与吻合口的相对位置关系,分为内部组和边缘组,并采用一种新型的吸切器切除肉芽组织。所有病例在切除后1周、2周、1个月、2个月、3个月、6个月和9个月进行随访,采用内镜检查、裂隙灯检查、荧光素染料消失试验和泪道冲洗试验等方法,评估切除的治疗效果和并发症,并采用χ2检验对两组患者的结果进行比较。结果 共纳入52例(52眼)患者。其中,内部组16例,边缘组36例。术后随访9个月,总成功率达86.5%,内部组成功率为87.5%,边缘组成功率为86.1%,两组患者比较,差异无统计学意义(P> 0.05);两组患者均未发生明显出血和其他并发症。结论新型吸切器切除En-DCR术后吻合口形成的肉芽组织,成功率高,并发症发生率低,是一种很好的选择。Objective To evaluate the efficiency of cutting off the granulation tissue,generating after endoscopic endonasal dacryocystorhinostomy(En-DCR),at the rhinostomy site by a novel suction and cutter instrument.Methods Patients diagnosed as primary acquired nasolacrimal duct obstruction from January 2017 to March 2020 were recruited and underwent En-DCR.The healing of the ostium and the presence of granulation tissue around it were mainly assessed post En-DCR by endoscopic examinations.The cases in which tear drainage function was influenced by the granulation tisse were enrolled. On the basis of the comparative position of granulation to the ostium, the cases were divided into inner group and edge group. The granulation tissue was cut off directly by a novel unique suction and cutter instrument. All the cases were followed up at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months and 9 months after excision. The incidence of granulation tissue formation after resection and the therapeutic effect of this operation were evaluated by several methods, such as endoscopy, slit lamp examination, fluorescein dye disappearence test, lacrimal passage flushing test, etc, and the results of the two groups were compared by chi square test. Results 52 patients (52 eyes) were enrolled in this study, among of them, 16 in inner group and 36 in edge group. With a follow-up of 9 months after granulation excision, the success rate was 86.5% in total, 87.5% in inner group and 86.1% in edge group. No statistical difference was found in success rate between the two groups (P > 0.05). And neither group showed significant bleeding or other complications. Conclusion As the high rate of success and low incidence of complications, we believe that granulation tissue excision by a novel suction-cutting instrument is a good choice for patients with granulation tissue formation at the ostium area after En DCR.

关 键 词：原发性获得性鼻泪管阻塞 鼻内镜下泪囊鼻腔吻合术 吻合口肉芽组织 新型吸切器 手术疗效 

分 类 号：R777.236[医药卫生—眼科]