Effect of endonasal endoscopic dacryocystorhinostomy combined with lacrimal duct drainage tube implantation in treating lacrimal duct obstruction
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摘要: 目的探讨鼻内镜下鼻腔泪囊吻合术(EES-DCR)同期植入泪道引流管治疗泪道阻塞的疗效。方法选择泪道阻塞行EES-DCR的患者32例(37眼)，包括功能性鼻泪管阻塞1例(2眼)，EES-DCR术后复发2例(2眼)，鼻泪管阻塞17例(19眼)，小泪囊6例(8眼)，泪小管及泪总管阻塞6例(6眼)。术中行EES-DCR，并自上、下泪小点植入泪道引流管，3例合并鼻中隔偏曲患者同期行鼻中隔成形术，1例合并慢性鼻窦炎患者同期行内镜鼻窦手术。术后鼻喷激素喷鼻治疗，随访时根据患者症状改善程度、泪道冲洗是否通畅及鼻内镜下泪囊鼻腔吻合口的开放状态对手术效果进行评估。结果术后随访3~30个月，治愈29例(34眼)，好转2例(2眼)，无效1例(1眼)，总有效率为97.3%(36/37)。所有患者均未出现眶内、颅内及鼻内并发症。结论EES-DCR联合泪道引流管植入治疗泪道阻塞性疾病安全有效。植入泪道引流管可有效避免造口堵塞，防止泪小管、泪总管黏连，手术成功率明显提高。Abstract: ObjectiveTo investigate the clinical effect of endonasal endoscopic dacryocystorhinostomy(EES-DCR) combined with lacrimal duct drainage tube implantation in treating the patients with lacrimal duct obstruction.Methods32 patients (37 eyes) with lacrimal duct obstruction were included into this study, including 1 patient (2 eyes) of functional nasal lacrimal duct obstruction, 2 patients (2 eyes) of recurrence after EES-DCR, 17 patients (19 eyes) of nasal lacrimal duct obstruction, 6 patients (8 eyes) of small lacrimal sac, and 6 patients (6 eyes) of lacrimal duct obstruction. Intraoperative EES-DCR was performed, and lacrimal drainage tubes were implanted from the upper and lower lacrimal points. Septoplasty was performed in 3 patients with nasal septum deviation, and endoscopic sinus surgery was performed in 1 patient with chronic sinusitis.After operation, nasal hormone spraying was performed. During follow-up, the operation effect was evaluated according to the degree of symptom improvement, the patency of lacrimal passage irrigation and the opening state of dacryocystorhinostomy under nasal endoscope.ResultsAfter 3-30 months of follow-up, 29 cases(34 eyes) were cured, 2 cases(2 eyes) were improved, and 1 case(1 eye) was ineffective. The total effective rate was 97.3%(36/37). No intraorbital, intracranial or nasal complications occurred in all patients.ConclusionEES-DCR combined with lacrimal duct drainage tube implantation is safe and effective in treating lacrimal duct obstruction. Implantation of lacrimal duct drainage tube can effectively avoid stoma blockage, prevent the adhesion of lacrimal duct, and significantly improve the success rate of surgery.
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