经鼻内镜低位泪囊鼻腔吻合联合新型RT人工泪管置入治疗慢性泪囊炎的临床初步报告  

Endonasal endoscopic lower position dacryocystorhinostomy combined with RT lacrimal stent intubation for treating chronic dacryocystitis

作　　者：周希彬[1] 陶海[1] 柳川[1] 白芳 王朋[1] 王立华 王菲[1] ZHOU Xibin;TAO Hai;LIU Chuan;BAI Fang;WANG Peng;WANG Lihua;WANG Fei(Senior Department of Ophthalmology,the Third Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心眼科医学部,北京100039

出　　处：《眼科学报》2025年第1期27-34,共8页Eye Science

基　　金：军队科研项目(BLB23C003)。

摘　　要：目的:研究经鼻内镜低位泪囊鼻腔吻合术联合RT新型人工泪管置入手术的临床有效性和安全性。方法:采用前瞻性随机对照研究,将临床诊断为原发性鼻泪管阻塞继发的慢性泪囊炎患者随机分为两组。研究组(A组)43例(44眼)采用低位经鼻内镜泪囊鼻腔吻合联合新型RT人工泪管置入术。对照组(B组)39例(39眼)采用常规经鼻内镜泪囊鼻腔吻合联合双泪小管置入式人工泪管置入。术后3~6个月取出人工泪管,随访时间1~12个月,平均6个月。观察术中术后的并发症,评估其安全性。结果:A组治愈42眼(95.45%),好转2眼(4.54%);B组治愈38眼(97.43%),好转1眼(2.56%),两组比较差异无统计学意义(P>0.05)。B组有12眼(30.77%)使用骨动力系统用于磨削骨质,A组未使用骨动力系统;A组手术时间为(31.88±1.64)min;B组手术时间为(48.54±4.40)min,两组比较差异有统计学意义(P<0.01);B组术后人工泪管从内眦脱出2例,A组在人工泪管置入或取出时,均无管体被拉断裂的病例,无人工泪管从内眦侧脱出的病例。两组患者术后均无人工泪管导致的泪点撕裂,术后随访平均6个月,均无复发。结论:低位经鼻内镜泪囊鼻腔吻合术联合RT新型人工泪管置入可以作为一种新的治疗慢性泪囊炎手术有效、安全的方法。Objective:To study the efficacy and safety of endonasal endoscopic lower position dacryocystorhinostomy(En-LP-DCR)combined with new RT lacrimal stent intubation for treating chronic dacryocystitis.Methods:In A prospective randomized controlled study,patients with chronic dacryocystitis secondary to primary nasolacrimal duct obstruction who met the inclusion criteria were randomly divided into two groups.In study group(Group A),43 cases(44 eyes)were treated with the En-LP-DCR combined with new RT lacrimal stent intubation.Control group(Group B),39 cases(39 eyes):conventional endoscopic dacryocystorhinostomy combined with bicanalicular intubation.The stent was removed from 3 to 6 months after surgery and followed up 6 to 12 months.Results:There was no recurrence of chronic dacryocystitis in both groups.In group A,42 eyes(95.45%)were cured and 2 eyes(4.54%)were improved.In group B,38 eyes were cured(97.43%)and 1 eye was improved(.56%),there was no significant difference between the two groups(P>0.05).In group B,12 eyes(30.77%)With the incorporation of powered instrumentation to make bony ostium with full exposure of the lacrimal sac.,while group A did not use powered dynamic system.Operation time of group A was(31.88±1.64)min;The operation time of group B was(48.54±4.40)min.The difference between the two groups was significant(P<0.01).In group B,the stent dislocated from the medial canthus in 2 cases,while in group A,there were no cases of the stent dislocated.No patient with dislocation,displacement of stent and punctum erosion founded in both groups,and no recurrence of chronic dacryocystitis was observed during the average follow-up of 6 months.Conclusion:Endonasal endoscopic lower position dacryocystorhinostomy combined with new RT lacrimal stent intubation is a new and effective method for the treatment of chronic dacryocystitis,with minimally surgical injury and faster postoperative recovery.

关 键 词：泪囊炎 人工泪管 鼻内镜 低位 泪囊鼻腔吻合术 

分 类 号：R777.23[医药卫生—眼科] R779.6[医药卫生—临床医学]