摘要
目的 探讨在进行泪囊鼻腔吻合手术（dacryorhinocystostomy,DCR）术中暴露Rosenm＆#252;ller瓣来治疗难治性鼻泪管阻塞的可行性,并探讨其临床意义.方法 选择难治性鼻泪管阻塞拟行DCR手术的患者36例（47眼）,包括置管后复发13例（15眼）,小泪囊18例（26眼）,DCR术后复发（鼻内及鼻外DCR各1例）2例（2眼）,功能性鼻泪管阻塞1例（2眼）,泪囊黏液囊肿1例（1眼）,外伤性鼻泪管阻塞1例（1眼）.术中尽量扩大骨窗并暴露Rosenm＆#252;ller瓣,如果泪囊太小且Rosenm＆#252;ller瓣狭窄则一期植入泪道引流管,合并慢性鼻-鼻窦炎、鼻中隔偏曲的患者同期进行内镜鼻窦手术及鼻中隔矫正手术.术后行泪道冲洗、布地奈德喷鼻剂喷鼻治疗,随访时根据患者症状是否改善、泪道冲洗的通畅程度以及鼻内镜下泪囊鼻腔吻合口的开放状态对DCR手术疗效进行评估.结果 术后随访3～36个月,32例（42眼）治愈,治愈率89.4％（42/47眼）,1例（1眼）有效,有效率2.1％（1/47眼）,总有效率91.5％（43/47眼）,4例（4眼）无效,无效率8.5％（4/47眼）.其中合并慢性鼻-鼻窦炎同期行内镜鼻窦手术4例、合并鼻中隔偏曲同期行鼻中隔偏曲矫正术2例,术后均恢复良好.所有病例均未出现眶壁损伤、大出血、脑脊液鼻漏、继发鼻-鼻窦炎、泪道泵功能受损等并发症.结论 对于难治性鼻泪管阻塞的患者,在行DCR手术中充分暴露Rosenm＆#252;ller瓣可以明显提高手术疗效,安全可靠,该方法具有并发症少,无颜面部瘢痕等优点,是治疗难治性鼻泪管阻塞的一种理想治疗手段.
Objective The objective of this study was to assess the efficacy of exposing Rosenm＆#252;ller valve during endonasal endoscopic dacryocystorhinostomy （EES-DCR） in treating refractory nasolacrimal duct obstruction.Methods Thirty six patients （47 eyes） with refractory nasolacrimal duct obstruction were entered into this study,including 13 patients （15 eyes） underwent nasal lacrimal duct intubation before,18 patients （26 eyes） with small lacrimal sac,2 patients underwent DCR before,1 patient with functional nasal lacrimal duct ohstruction,1 patient with lacrimal mucocele,1 patient with nasal trauma.During the DCR,the bone window was enlarged as wide as possible and the valve of Rosenm＆#252;ller was exposed.The intubation of the lacrimal apparatus was performed if the lacrimal sac was very small and the Rosenm＆#252;ller valve was tight.Functional endoscopic sinus surgery and septoplasty were performed simultaneously if necessary.Postoperatively,each patient was assessed by the symptom and nasal endoscopy.Results The postoperative follow-up period ranged from 3 to 36 months.Thirty two patients（89.4%,42/47 eyes） were cured,which presented as the disappearance of symptoms,the patency of the lacrimal ostium and the lacrimal duct irrigation was clear.One patient （2.1%,1/47 eyes） was improved,which presented as the improvement of symptoms,a few hypertrophic scar around the lacrimal ostium and the lacrimal duct irrigation was clear.Four cases failed （8.5%,4/47）,which presented as symptomatic and obstruction of the lacrimal ostium.The total effective rate reached to 91.5%.No serious postoperative complications were found in all cases.Conclusions To expose Rosenm＆#252;ller valve during endoscopic DCR in treating patients with refractory nasolacrimal duct obstruction could obviously increase the operative success rate,fewer complications,with no facial surgical scar.It is an ideal way to treat the refractory nasolacrimal duct obstruction.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2016年第7期522-527,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
