鼻内镜下经鼻泪囊鼻腔吻合术治疗复发性泪囊炎的临床效果  

Clinical efficacy of transnasal endoscopic dacryocystorhinostomy in the treatment of recurrent dacryocystitis

作　　者：王婷婷 戈振华 王雪颖 魏子岳 章志扬 Wang Tingting;Ge Zhenhua;Wang Xueying;Wei Ziyue;Zhang Zhiyang(Department of Ophthalmology,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Eye Institute of Xuzhou,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属徐州市立医院眼科、徐州市眼病防治研究所,徐州221002

出　　处：《中华眼外伤职业眼病杂志》2023年第4期310-314,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价鼻内镜下经鼻泪囊鼻腔吻合术治疗复发性泪囊炎的临床效果。方法回顾性病例系列研究。选取徐州医科大学附属徐州市立医院2018年1月至2022年6月住院行鼻内镜下经鼻泪囊鼻腔吻合术治疗的复发性泪囊炎31例(31眼)的临床资料,其中泪道置管术后管留置复发者9例,外路泪囊鼻腔吻合术后复发者12例,鼻内镜下泪囊鼻腔吻合术后复发者10例。术后随访3个月至1年,分析患者复发原因,观察吻合口是否开放、泪道冲洗结果及术后症状改善情况。结果泪道置管术后复发者复发原因为泪囊黏膜增生肥厚导致泪囊腔变小,影响泪液引流;泪囊鼻腔吻合术后复发者复发原因有:骨窗制作不适19例(86.36%)、吻合口与鼻腔粘连者4例(18.18%)、泪囊黏膜误与鼻窦黏膜吻合者1例(4.54%)。31例均行经鼻内镜下泪囊鼻腔吻合术,29例吻合口开放,冲洗泪道通畅,溢泪、溢脓症状消失,均治愈,2例有轻微溢泪,吻合口开放,泪道冲洗通畅,溢脓症状消失,均好转,治愈率93.55%,有效率100.00%。结论鼻内镜下泪囊鼻腔吻合术治疗复发性泪囊炎损伤小,疗效确切,手术成功率高。Objective To evaluate the clinical efficacy of trans-nasal endoscopic dacryocystorhinostomy in the treatment of recurrent dacryocystitis.Methods This was a retrospective case series study.The clinical data of 31 eyes of 31 patients with recurrent dacryocystitis treated by transnasal endoscopic dacryocystorhinostomy in Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from Jan.2018 to Jun.2022 were selected.There were 9 patients with indwelling stent after lacrimal duct intubation,12 patients with recurrence after external dacryocystorhinostomy,and 10 patients with recurrence after transnasal endoscopic dacryocystorhinostomy.The follow-up time was 3 months to 1 year.The reasons for recurrence were analyzed,and the results of anastomotic opening,lacrimal duct irrigation and postoperative symptom improvement were observed.Results The reason for relapse after lacrimal duct intubation was that lacrimal sac became smaller due to hyperplasia and hypertrophy of lacrimal sac mucosa,which affected tear drainage.The reasons for recurrence after dacryocystorhinotomy were as follows:improper making of bone ostium in 19 cases(86.36%),adhesion between anastomosis and nasal cavity in 4 cases(18.18%),and incorrect anastomosis between dacryocystis mucosa and sinus mucosa in 1 case(4.54%).All the 31 cases underwent transnasal endoscopic dacryocystorhinostomy,and 29 cases of which were cured with open anastomosis and smooth lacrimal duct irrigation.In 31 cases,2 cases had mild tear overflow,anastomotic opening,lacrimal duct flushes smoothly,pyorrhea symptoms disappeared,and all of them were improved.The cure rate of 31 patients with recurrent dacryocystitis who underwent transnasal endoscopic dacryocystorhinostomy was 93.55%and the effective rate was 100.00%.Conclusion Endoscopic transnasal dacryocystosinostomy for the treatment of recurrent dacryocystitis has the advantages of less damage,accurate efficacy and high success rate of surgery.

关 键 词：泪囊鼻腔吻合术 鼻内镜 泪囊炎 复发性 置管术 泪道 造影 CT 

分 类 号：R779.6[医药卫生—眼科]