橡胶导尿管在经鼻内镜泪囊鼻腔吻合术中的应用
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摘要
目的探讨橡胶导尿管在经鼻内镜泪囊鼻腔黏膜吻合术(endoscopic dacryocystorhinostomy,En-DCR)治疗慢性泪囊炎中的应用价值。方法 2017年11月～2018年6月,应用En-DCR治疗单眼慢性泪囊炎73例,其中41例切开泪囊后应用橡胶导尿管支撑泪囊黏膜和鼻黏膜的吻合口(橡胶导尿管组),32例以透明质酸钠凝胶填充泪囊,覆盖吻合口(透明质酸钠组)。比较2组泪囊造口时间(自泪囊完全暴露至贴敷明胶海绵),以及术后4个月Munk功能学、Park解剖学评分和成功率。结果橡胶导尿管组泪囊造口时间比透明质酸钠组短[(21. 1±4. 3) min vs.(27. 4±4. 7) min,t=-5. 956,P=0. 000],2组术后4个月Munk功能学评分、Park解剖学评分均无统计学差异(P> 0. 05),橡胶导尿管组功能学和解剖学成功率均为85. 4%(35/41),透明质酸钠组均为81. 2%(26/32),2组无统计学差异(χ~2=0. 222,P=0. 638)。结论在En-DCR治疗慢性泪囊炎术中,应用橡胶导尿管支撑泪囊黏膜和鼻黏膜吻合口辅助手术可缩短手术时间,但长期效果尚待进一步研究。
Objective To investigate the effect of rubber catheters in the treatment of chronic dacryocystitis with endoscopic dacryocystorhinostomy( En-DCR). Methods A total of 73 patients with chronic dacryocystitis were treated with En-DCR from November 2017 to June 2018. The rubber catheter was applied to support the dacryocyst mucosa and nasal mucosa in 41 cases( rubber catheter group),while the sodium hyaluronate gel was injected into the lacrimal sac via upper puncta to brace the lacrimal sacs after it was fully exposed in 32 cases( sodium hyaluronate group). The dacryocystomy time( from the exposure of lacrimal sacs to the ending of application of gelatin sponge),Munk functional score,Park anatomical score and success rate after 4 months were compared.Results The dacryocystomy time of the rubber catheters group was shorter than the sodium hyaluronate group [( 21. 1 ± 4. 3) min vs.( 27. 4 ± 4. 7) min,t =-5. 956,P = 0. 000]. The Munk functional and Park anatomical scores had no statistical differences between the two groups( P > 0. 05). The success rates were 85. 4%( 35/41) in the rubber catheter group and 81. 2%( 26/32) in the sodium hyaluronate group( χ~2= 0. 222,P = 0. 638). Conclusion Application of rubber catheters in the En-DCR in the treatment of chronic dacryocystitis can simplify the operation and shorten the operation time,while the postoperative effect remains to be further researched.
Objective To investigate the effect of rubber catheters in the treatment of chronic dacryocystitis with endoscopic dacryocystorhinostomy( En-DCR). Methods A total of 73 patients with chronic dacryocystitis were treated with En-DCR from November 2017 to June 2018. The rubber catheter was applied to support the dacryocyst mucosa and nasal mucosa in 41 cases( rubber catheter group),while the sodium hyaluronate gel was injected into the lacrimal sac via upper puncta to brace the lacrimal sacs after it was fully exposed in 32 cases( sodium hyaluronate group). The dacryocystomy time( from the exposure of lacrimal sacs to the ending of application of gelatin sponge),Munk functional score,Park anatomical score and success rate after 4 months were compared.Results The dacryocystomy time of the rubber catheters group was shorter than the sodium hyaluronate group [( 21. 1 ± 4. 3) min vs.( 27. 4 ± 4. 7) min,t =-5. 956,P = 0. 000]. The Munk functional and Park anatomical scores had no statistical differences between the two groups( P > 0. 05). The success rates were 85. 4%( 35/41) in the rubber catheter group and 81. 2%( 26/32) in the sodium hyaluronate group( χ~2= 0. 222,P = 0. 638). Conclusion Application of rubber catheters in the En-DCR in the treatment of chronic dacryocystitis can simplify the operation and shorten the operation time,while the postoperative effect remains to be further researched.
引文
1 Eshraghi B,Abdi P,Akbari M,et al. Microbiologic spectrum of acute and chronic dacryocystitis. Int J Ophthalmol,2014,7(5):864-867.
2 Huang J,Malek J,Chin D,et al. Systematic review and meta-analysis on outcomes for endoscopic versus external dacryocystorhinostomy.Orbit,2014,33(2):81-90.
3 Das SK,Sarkar P,Dan A,et al. Endoscopic dacryocystorhinostomy:a study at IPGMER,Kolkata. Indian J Otolaryngol Head Neck Surg,2013,65(Suppl 2):366-370.
4 Ragab SM,el-Koddousy MS,Badr M. Endocanalicular,high-pressure balloon catheter,endoscopic dacryocystorhinostomy:a randomized controlled trial. Otolaryngol Head Neck Surg,2011,145(4):683-688.
5 周吉超,倪薇,刘海华,等.透明质酸钠在经鼻内镜泪囊鼻腔吻合术中的应用.中国微创外科杂志,2018,18(2):143-147.
6 廖凯.临床诊疗指南简介.中国执业药师,2012,9(2):51-54.
7 Tsirbas A, Davis G, Wormald PJ. Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy.Ophthal Plast Reconstr Surg,2004,20(1):50-56.
8 Munk PL,Lin DT,Morris DC. Epiphora:treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology,1990,177(3):687-690.
9 Park J,Lee J,Jang S,et al. Effectiveness of sodium hyaluronate(Protad)application in endoscopic endonasal dacryocystorhinostomy.Can J Ophthalmol,2017,52(2):192-197.
10 Hodgson N,Bratton E,Whipple K,et al. Outcomes of endonasal dacryocystorhinostomy without mucosal flap preservation. Ophthal Plast Reconstr Surg,2014,30(1):24-27.
11 Peng W,Tan B,Wang Y,et al. A modified preserved nasal and lacrimal flap technique in endoscopic dacryocystorhinostomy. Sci Rep,2017,7(1):6809.
12 Lombardi D,Mattavelli D,Accorona R,et al. Acute dacryocystitis with empyema of the lacrimal sac:is immediate endoscopic dacryocystorhinostomy justified? Otolaryngol Head Neck Surg,2014,150(6):1071-1077.
13 Moore WM,Bentley CR,Olver JM. Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy:surgical and holmium laser. Ophthalmology,2002,109(8):1575-1582.
14 王锋,王德辉.鼻内镜下泪囊鼻腔造口术的疗效分析.中国眼耳鼻喉科杂志,2011,11(5):298-300.
15 Rose GE. The lacrimal paradox:toward a greater understanding of success in lacrimal surgery. Ophthal Plast Reconstr Surg,2004,20(4):262-265.
16 Yazici B,Yazici Z. Frequency of the common canaliculus:a radiological study. Arch Ophthalmol,2000,118(10):1381-1385.
17 Leong SC,Macewen CJ,White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy,2010,24(1):81-90.
18 Zuercher B,Tritten JJ,Friedrich JP,et al. Analysis of functional and anatomic success following endonasal dacryocystorhinostomy. Ann Otol Rhinol Laryngol,2011,120(4):231-238.
19 Hurwitz JJ, Nik N. Lacrimal sac identification for dacryocystorhinostomy:the role of sodium hyaluronate. Can J Ophthalmol,1984,19(3):112-114.
20 Wu W,Cannon PS,Yan W,et al. Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis. Eye(Lond),2011,25(6):746-753.
2 Huang J,Malek J,Chin D,et al. Systematic review and meta-analysis on outcomes for endoscopic versus external dacryocystorhinostomy.Orbit,2014,33(2):81-90.
3 Das SK,Sarkar P,Dan A,et al. Endoscopic dacryocystorhinostomy:a study at IPGMER,Kolkata. Indian J Otolaryngol Head Neck Surg,2013,65(Suppl 2):366-370.
4 Ragab SM,el-Koddousy MS,Badr M. Endocanalicular,high-pressure balloon catheter,endoscopic dacryocystorhinostomy:a randomized controlled trial. Otolaryngol Head Neck Surg,2011,145(4):683-688.
5 周吉超,倪薇,刘海华,等.透明质酸钠在经鼻内镜泪囊鼻腔吻合术中的应用.中国微创外科杂志,2018,18(2):143-147.
6 廖凯.临床诊疗指南简介.中国执业药师,2012,9(2):51-54.
7 Tsirbas A, Davis G, Wormald PJ. Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy.Ophthal Plast Reconstr Surg,2004,20(1):50-56.
8 Munk PL,Lin DT,Morris DC. Epiphora:treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology,1990,177(3):687-690.
9 Park J,Lee J,Jang S,et al. Effectiveness of sodium hyaluronate(Protad)application in endoscopic endonasal dacryocystorhinostomy.Can J Ophthalmol,2017,52(2):192-197.
10 Hodgson N,Bratton E,Whipple K,et al. Outcomes of endonasal dacryocystorhinostomy without mucosal flap preservation. Ophthal Plast Reconstr Surg,2014,30(1):24-27.
11 Peng W,Tan B,Wang Y,et al. A modified preserved nasal and lacrimal flap technique in endoscopic dacryocystorhinostomy. Sci Rep,2017,7(1):6809.
12 Lombardi D,Mattavelli D,Accorona R,et al. Acute dacryocystitis with empyema of the lacrimal sac:is immediate endoscopic dacryocystorhinostomy justified? Otolaryngol Head Neck Surg,2014,150(6):1071-1077.
13 Moore WM,Bentley CR,Olver JM. Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy:surgical and holmium laser. Ophthalmology,2002,109(8):1575-1582.
14 王锋,王德辉.鼻内镜下泪囊鼻腔造口术的疗效分析.中国眼耳鼻喉科杂志,2011,11(5):298-300.
15 Rose GE. The lacrimal paradox:toward a greater understanding of success in lacrimal surgery. Ophthal Plast Reconstr Surg,2004,20(4):262-265.
16 Yazici B,Yazici Z. Frequency of the common canaliculus:a radiological study. Arch Ophthalmol,2000,118(10):1381-1385.
17 Leong SC,Macewen CJ,White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy,2010,24(1):81-90.
18 Zuercher B,Tritten JJ,Friedrich JP,et al. Analysis of functional and anatomic success following endonasal dacryocystorhinostomy. Ann Otol Rhinol Laryngol,2011,120(4):231-238.
19 Hurwitz JJ, Nik N. Lacrimal sac identification for dacryocystorhinostomy:the role of sodium hyaluronate. Can J Ophthalmol,1984,19(3):112-114.
20 Wu W,Cannon PS,Yan W,et al. Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis. Eye(Lond),2011,25(6):746-753.