新型硅胶支撑管在鼻内镜下泪囊鼻腔造口术治疗慢性泪囊炎中的应用  

Application of new type silicone stent in endoscopic dacryocystorhinostomy for the treatment of chronic dacryocystitis

作　　者：蔡军 袁鹂[2] 环梦佳[2] 孙长策 Cai Jun;Yuan Li;Huan Mengjia;Sun Changce(Department of Ophthalmology,Nanjing Third Hospital(Sarjiawan Hospital,the Second Affiliated Hospital of Nanjing Medical University),Nanjing 210003,China;Department of Ophthalmology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京市第三医院(南京医科大学第二附属医院萨家湾院区)眼科,南京210003 [2]南京医科大学第二附属医院眼科,南京210011

出　　处：《中华眼外伤职业眼病杂志》2024年第7期518-523,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评估新型硅胶支撑管应用于鼻内镜下泪囊鼻腔造口术治疗慢性泪囊炎的临床效果。方法回顾性病例系列研究。纳入南京市第三医院2022年1月至2023年9月住院的慢性泪囊炎156例(156眼)患者,采用鼻内镜下泪囊鼻腔造口联合新型硅胶支撑管置管术治疗。术后3个月拔管,拔管后随访3个月,观察治疗效果和并发症。结果随访期末,治愈141例,好转6例,无效9例,治愈率90.38%(141/156),手术成功率94.23%(147/156)。其中6例好转患者因瘢痕收缩,造口狭窄包裹硅胶支撑管,经放射状切开增生的鼻黏膜瘢痕组织。无效9例中,4例鼻中隔偏曲合并急慢性鼻窦炎;4例小泪囊合并泪总管阻塞;1例未随访复查,拔管后,造口完全闭塞。全部手术未有严重并发症发生。随访期间无严重并发症发生。术后1个月1例发生硅胶支撑管脱落,未影响术后疗效;1例发生球后出血,经冷敷止血处理后缓解。术后3 d 1例拔除聚乙烯醇海绵后出现鼻部出血,经填塞止血后缓解。结论鼻内镜下泪囊鼻腔造口术联合新型硅胶支撑管植入术可有效治疗慢性泪囊炎。Objective To evaluate the clinical efficacy of a new type of silicone stent in the treatment of chronic dacryocystitis with endoscopic dacryocystorhinostomy.Methods This was a retrospective case series study.A total of 156 cases(156 eyes)of chronic dacryocystitis hospitalized in Nanjing Third Hospital from Jan.2022 to Sep.2023 were treated by endoscopic dacryocystorhinostomy combined with new type of silicone stent catheterization.The duration of follow-up was 3 months after extubation at 3 months postoperatively to observe the efficacy and complication.Results At the end of the follow-up period,141 cases were cured,6 cases improved,with ineffectiveness in 9 cases.The cure rate was 90.38%(141/156),and the success rate of surgery was 94.23%(147/156).Among them,6 cases of improved patients due to scar contraction and narrow silicone stent received radial incision of the hyperplastic scar tissue of the nasal mucosa.Among the 9 ineffective cases,4 cases had nasal septal deviation with acute and chronic sinusitis,4 cases had small lacrimal sac with common lacrimal duct obstruction,and 1 case was left without follow-up review.However,complete stoma occlusion recurred after extubation.No serious complications occurred in all of the operations.One case had silicone stent tube shedding at 1 month after surgery,which did not affect the postoperative efficacy;1 case had retrobulbar hemorrhage,which was relieved after symptomatic treatment with cold application.At 3 days after surgery,1 case developed nasal hemorrhage after removal of the polyvinyl alcohol sponge,which was relieved after hemostatic tamponade.Conclusion Endoscopic dacryocystorhinostomy combined with new type of silicone stent implantation is effective in the treatment of chronic dacryocystitis.

关 键 词：支撑管 硅胶 新型 泪囊炎 慢性 泪囊鼻腔造口术 鼻内镜下 

分 类 号：R779.6[医药卫生—眼科]