泪囊鼻腔黏膜瓣360度吻合联合支架植入治疗慢性泪囊炎的效果  

Efficacy of dacryocystorhinostomy with circumferential anastomosis combined with stoma stent implantation in the treatment of chronic dacryocystitis

作　　者：解传奇[1] 肖丽 马红[1] 张令令[2] Xie Chuanqi;Xiao Li;Ma Hong;Zhang Lingling(Department of Ophthalmology,the First People’s Hospital of Shangqiu,Shangqiu 476000,China;Shangqiu Medical College,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院眼科,商丘476000 [2]商丘医学高等专科学校,商丘476000

出　　处：《中华眼外伤职业眼病杂志》2023年第7期504-509,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关计划联合共建项目(2018020945)。

摘　　要：目的评估经皮入路泪囊鼻腔黏膜瓣360度吻合联合吻合口支架植入术治疗慢性泪囊炎的效果。方法回顾性病例对照研究。纳入商丘市第一人民医院2018年5月至2022年3月慢性泪囊炎67例(67眼)。根据手术方式将患者分为两组,试验组31例(31眼),术中使用泪囊鼻腔黏膜瓣360度吻合联合吻合口支架植入;对照组36例(36眼),术中使用泪囊鼻腔黏膜两瓣吻合术。试验组术后1个月拔除吻合口支架。两组患者均于术后每月行泪道冲洗和鼻内窥镜检查。随访4个月,对比两组术后泪道通畅和吻合口开放情况。结果随访期末试验组治愈26例,好转3例,无效2例,有效率93.55%(29/31);对照组治愈22例,好转4例,无效10例,有效率72.22%(26/36),差异有统计学意义(χ^(2)=5.15,P=0.023)。术后4个月,对照组吻合口开放26例,闭塞9例,吻合口开放率为75.00%;试验组吻合口开放29例,闭塞2例,吻合口开放率为93.55%,两组差异有统计学意义(χ^(2)=4.18,P=0.041)。结论经皮入路泪囊鼻腔黏膜瓣360度吻合术实现了骨窗边缘黏膜组织全覆盖,术中联合吻合口支架植入可以增加吻合口开放率,提高手术成功率。Objective To evaluate the clinical efficacy of percutaneous dacryocystorhinostomy with circumferential anastomosis combined with stoma stent implantation in the treatment of chronic dacryocystitis.Methods A retrospective case control study was conducted.The data of 67 eyes of 67 patients with chronic dacryocystitis from May 2018 to Mar.2022 in the First People’s Hospital of Shangqiu were analyzed.Patients were divided into two groups based on the surgical methods.Thirty-one eyes of 31 patients underwent circumferential anastomosis combined with stoma stent implantation as the clinical trial group,while 36 eyes of 36 patients underwent two-flap anastomosis as the control group.The stoma stent was removed at 1 month after surgery in the clinical trial group.Both groups underwent lacrimal duct flushing and nasal endoscopic examination monthly after surgery and were followed up for 4 months.The postoperative patency of the lacrimal duct and stomal opening were compared between the two groups.Results At the end of the follow-up period,26 cases were cured,3 cases improved,and 2 cases were ineffective in the clinical trial group,with an effective rate of 93.55%(29/31).In the control group,22 cases were cured,4 cases improved,and 10 cases were ineffective,with an effective rate of 72.22%(26/36).The effective rate in the clinical trial group was higher than that in the control group(χ^(2)=5.15,P=0.023).At 4 months postoperatively,the stomal opening rate was 75.00%in the control group,with 26 cases open and 9 cases occluded.The stomal opening rate was 93.55%in the clinical trial group,with 29 cases open and 2 cases occluded,which was higher than that in the control group(χ^(2)=4.18,P=0.041).Conclusion The use of circumferential anastomosis combined with stoma stent implantation in percutaneous dacryocystorhinostomy achieves complete coverage of the bone window edge with mucosal tissue and increases the stomal opening rate,thereby improving the success rate of the surgery.

关 键 词：慢性泪囊炎 泪囊鼻腔吻合术 经皮肤 吻合 黏膜瓣 360度 支架 吻合口 

分 类 号：R779.6[医药卫生—眼科]