【摘要】：目的:本研究將納吸棉(Nasopore)用于內(nèi)鏡下鼻腔淚囊吻合術(shù)(Endoscopical transnasal dacryocystorhinostomy,Et-DCR)中填充并支撐淚囊造瘺口,觀察其對(duì)慢性淚囊炎術(shù)后療效的影響。方法:收集河北醫(yī)科大學(xué)第二醫(yī)院眼科2015年8月至2016年8月期間收治的慢性淚囊炎患者80例(81眼)。所有入選的患者術(shù)前行全面的眼科檢查、淚道沖洗檢查、淚囊造影檢查和鼻腔檢查。按照造瘺口處是否填充納吸棉分為A、B兩組,A組50例(51眼),行內(nèi)鏡下鼻腔淚囊吻合術(shù),造瘺口處填充納吸棉,黏膜瓣對(duì)合處及骨質(zhì)暴露部位覆蓋納吸棉,女42例(43眼),男8例(8眼),右眼29只,左眼22只,平均年齡51.04±2.04歲,平均病程7.22±0.53年,淚囊平均大小為:0.51±0.03cm3;B組30例(30眼),行內(nèi)鏡下鼻腔淚囊吻合術(shù),僅黏膜瓣對(duì)合處及骨質(zhì)暴露部位覆蓋納吸棉,而造瘺口處不填充納吸棉,女24例(24眼),男6例(6眼),右眼18只,左眼12只,平均年齡46.67±2.79歲,平均病程5.87±0.59年,淚囊平均大小為:0.52±0.05cm3。淚囊大小是通過(guò)CT淚囊造影計(jì)算,計(jì)算機(jī)測(cè)量軟件測(cè)量淚囊的水平徑、垂直徑及矢狀徑,最終淚囊大小=水平徑×垂直徑×矢狀徑,觀察兩組在性別、眼別、年齡、病程、淚囊大小方面差異是否有統(tǒng)計(jì)學(xué)意義。分別于術(shù)后1個(gè)月、3個(gè)月、6個(gè)月行內(nèi)鏡檢查,i觀察患者有無(wú)溢淚、流膿癥狀,ii沖淚道是否通暢,iii內(nèi)鏡下觀察吻合口是否開(kāi)放,將以上三項(xiàng)作為評(píng)判術(shù)后淚道重建是否成功的標(biāo)準(zhǔn),比較兩組術(shù)后1個(gè)月、3個(gè)月、6個(gè)月時(shí)淚道重建的成功率及肉芽增生和/或瘢痕形成率。結(jié)果:本次研究共80例患者81眼,其中A組50例51眼,B組30例30眼。兩組在年齡、性別、眼別、病程、淚囊大小方面均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。分別于術(shù)后1個(gè)月、3個(gè)月、6個(gè)月行內(nèi)鏡檢查。1淚道重建成功率的比較:術(shù)后1月:A組淚道重建成功50例51眼(51/51,100.0%),B組淚道重建成功25例25眼(25/30,83.3%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ2=6.410 P=0.011)。術(shù)后3月:A組手術(shù)成功49例50眼(50/51,98.0%),B組手術(shù)成功23例23眼(23/30,76.7%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ2=7.441 P=0.006)。術(shù)后6月:A組手術(shù)成功48例49眼(49/51,96.1%),B組手術(shù)成功21例21眼(21/30,70.0%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(χ2=8.837 P=0.003)2吻合口處肉芽增生和/或瘢痕形成率的比較:術(shù)后1個(gè)月:A組吻合口處肉芽增生2例2眼,尚未影響吻合口的開(kāi)放;B組5例5眼均因吻合口處肉芽過(guò)度增生導(dǎo)致吻合口閉鎖。術(shù)后3個(gè)月:A組共4例4眼吻合口處肉芽增生,其中1例1眼因吻合口處肉芽過(guò)度增生導(dǎo)致吻合口閉鎖,3例3眼尚未影響吻合口的開(kāi)放;B組共9例9眼吻合口處肉芽增生,其中7例7眼因肉芽過(guò)度增生導(dǎo)致吻合口閉鎖,2例2眼尚未影響吻合口的開(kāi)放。術(shù)后6個(gè)月:A組共4例4眼吻合口處瘢痕形成,其中2例2眼未影響吻合口的開(kāi)放,2例2眼瘢痕形成,吻合口閉鎖;B組共9例9眼吻合口處瘢痕形成,吻合口閉鎖。A組中吻合口處肉芽增生和/或瘢痕形成共4例4眼(4/51,7.8%),B組中吻合口處肉芽增生和/或瘢痕形成共9例9眼(9/30,30.0%),兩組差異有統(tǒng)計(jì)學(xué)意義(χ2=5.336,P=0.021)。結(jié)論:在內(nèi)鏡下鼻腔淚囊吻合術(shù)中,納吸棉可有效地支撐造瘺口,并可抑制肉芽增生和瘢痕形成,從而保持吻合口的開(kāi)放,提高手術(shù)成功率,值得在臨床上推廣利用。
[Abstract]:Objective: To investigate the effect of nasopore on the postoperative efficacy of dacryocystorhinostomy (Et-DCR) in patients with chronic dacryocystitis. 80 patients (81 eyes) with chronic dacryocystitis were enrolled in this study. All the patients underwent comprehensive ophthalmic examination, lacrimal irrigation, dacryocystography and nasal examination before operation. 42 women (43 eyes), 8 men (8 eyes), 29 right eyes, 22 left eyes, mean age 51.04 (+ 2.04) years, mean course 7.22 (+ 0.53) years, average size of lacrimal sac: 0.51 (+ 0.03 cm 3); 30 patients (30 eyes) in group B underwent endoscopic dacryocystorhinostomy with mucosal flap covering only suction cotton and bone exposure sites, while the fistula was made. 24 cases (24 eyes) were female, 6 cases (6 eyes) were male, 18 eyes were right, 12 eyes were left, the average age was 46.67 + 2.79 years, the average course of disease was 5.87 + 0.59 years, the average size of lacrimal sac was: 0.52 + 0.05 cm 3. The size of lacrimal sac was calculated by CT dacryocystography. The horizontal diameter, vertical diameter and sagittal diameter of lacrimal sac were measured by computer software. The difference of sex, eye sex, age, course of disease and size of lacrimal sac between the two groups was observed. Endoscopic examination was performed at 1 month, 3 months and 6 months after operation. I observed whether the patients had epiphora, purulent symptoms, whether the I I lacrimal passage was unobstructed, and whether the anastomosis was open under I I I endoscopy. The success rate of lacrimal duct reconstruction and the formation rate of granulation hyperplasia and/or scar were compared between the two groups at 1 month, 3 months and 6 months after operation. Results: 81 eyes of 80 patients were studied, 50 eyes in group A and 30 eyes in group B. The success rate of lacrimal duct reconstruction in group A was 51 eyes (51/51,100.0%) in 50 cases and 25 eyes (25/30,83.3%) in group B. The difference between the two groups was statistically significant (2=6.410 P=0.011). 3 months after operation, the success rate of lacrimal duct reconstruction in group A was 49 cases (50 eyes) (5.011 eyes). Six months after operation, 48 cases (49/51,96.1%) in group A were successful, 21 cases (21/30,70.0%) in group B were successful, and the difference between the two groups was statistically significant (2=8.837 P=0.006). One month after operation, 2 eyes in group A had granulomatous hyperplasia at the anastomotic site, which did not affect the anastomotic opening; 5 eyes in group B had anastomotic atresia due to granulomatous hyperplasia at the anastomotic site. 3 months after operation, 4 eyes in group A had granulomatous hyperplasia at the anastomotic site, 1 eye had anastomotic atresia due to granulomatous hyperplasia at the anastomotic site, 3 eyes had anastomotic atresia due to granulomatous hyperplasia In group B, 9 eyes of 9 cases had granulomatous hyperplasia, 7 eyes had atresia due to granulomatous hyperplasia, and 2 eyes had not affected the opening of anastomotic stoma. In group A, 4 cases (4/51,7.8%) had granulomatous hyperplasia and/or scar formation at anastomotic site, and in group B, 9 cases (9/30,30.0%) had granulomatous hyperplasia and/or scar formation at anastomotic site. The difference between the two groups was statistically significant (2=5.336, P=0.021). Conclusion: In endoscopic dacryocystorhinostomy, granulomatosis and/or scar formation were found in 4 cases (4/51,7.8%). Cotton aspiration can effectively support the stoma, inhibit granulation hyperplasia and scar formation, thus keeping the anastomotic opening and improving the success rate of surgery, which is worthy of clinical application.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6

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