摘要
目的:观察分析鼻内镜下泪囊鼻腔吻合术中不同吻合方式的疗效。方法:前瞻性随机对照研究。连续纳入2019年12月至2022年12月于武汉大学附属爱尔眼科医院施行鼻内镜下泪囊鼻腔吻合术的慢性泪囊炎患者,双眼患者双眼纳入,按眼编码,采用随机数字表法分为A、B、C 3组。A组泪囊瓣与鼻黏膜瓣相互重叠,B组泪囊瓣与鼻黏膜瓣游离端相互连接、紧密接触,C组泪囊瓣与鼻黏膜瓣游离端分离、互不接触。记录患者术前与术后3个月时的Munk评分,分别于术后3周、2个月、3个月行泪道冲洗检查及鼻内镜检查,观察术后吻合口5 mm内肉芽组织增生情况及术后3个月时吻合口生长情况,评估并记录疗效。采用Kruskal-WallisH检验、Bonferroni校正检验及Wilcoxon符号秩检验进行数据分析。结果:随访至术后3个月,共纳入112例(157眼),其中男32眼,女125眼,年龄(52.8±10.9)岁。其中A组49眼,B组57眼,C组51眼。术前3组Munk评分差异无统计学意义。术后3周时,3组肉芽组织增生情况差异有统计学意义(χ^(2)=19.38,P<0.001),组间两两比较显示C组吻合口5 mm内肉芽组织形成的发生率低于A组及B组,B组低于A组(均P<0.05)。术后3个月时,所有患者Munk评分低于术前(P<0.001),3组术后Munk评分差异有统计学意义(χ^(2)=23.71,P<0.001),组间两两比较显示C组Munk评分低于A组及B组,B组低于A组(均P<0.05)。3组间术后成功率差异有统计学意义(χ^(2)=15.74,P<0.001),组间两两比较时,B组及C组成功率高于A组(均P<0.05),B、C 2组成功率差异无统计学意义(P>0.05)。3组术后治愈率差异有统计学意义(χ^(2)=23.79,P<0.001),组间两两比较时,C组治愈率高于A组及B组(均P<0.05),B组治愈率高于A组(P=0.004)。结论:鼻内镜下泪囊鼻腔吻合术中将泪囊瓣与鼻黏膜瓣互相分离、互不接触能有效减少术后吻合口肉芽组织形成的发生率,使吻合口形成更趋于完美,同时提高了手术疗效,进一步减轻了患者术后溢泪症状。
Objective:To evaluate the clinical efficacy of different anastomosis methods in endoscopic dacryocystorhinostomy.Methods:This was a prospective randomized controlled study.Chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy at Aier Eye Hospital of Wuhan University from December 2019 to December 2022 were included.Patients with bilateral dacryocystorhinostomy were included and randomly assigned to three groups:A,B,and C using a random number table method.The lacrimal sac flap and nasal mucosal flap of Group A overlapped with each other,the free end of the lacrimal sac flap and nasal mucosal flap in Group B were connected and in close contact with each other,the free end separation and non-contact between the lacrima sac flap and nasal mucosal flap in Group C.The Munk score was recorded preoperatively and 3 months postoperatively,and lacrimal irrigation examination and nasal endoscopy were performed at 3 weeks,2 months,and 3 months postoperatively.The proliferation of granulation tissue within 5 mm of the stoma and the growth of the stoma were observed at 3 months postoperatively,and the therapeutic effect was evaluated and recorded.Statistical analyses included the Kruskal-Wallis H test,Bonferroni correction,and Wilcoxon signed-rank test.Results:A total of 112 cases(157 eyes)were included in the follow-up up to 3 months postoperative,with 32 eyes for males and 125 eyes for females,with an average age of 52.8±10.9 years.Including 49 eyes in Group A,57 eyes in Group B,and 51 eyes in Group C.There was no significant difference in Munk scores among the three preoperative groups.At 3 weeks postoperative,there was a significant difference in the proliferation of granulation tissue among the three groups(χ^(2)=19.38,P<0.001).Paired comparisons between the groups showed that the incidence of granulation tissue formation within 5 mm of the stoma in Group C was lower than that in Group A and Group B,and Group B was lower than Group A(all P<0.05).At 3 months postoperative,the all patient's Munk score was lower than preoperative(P<0.001),and there was a significant difference in the postoperative Munk scores among the three groups(χ^(2)=23.71,P<0.001).Pairwise comparisons between groups showed that the Munk scores in Group C were lower than those in Group A and Group B,while those in Group B were lower than those in Group A(all P<0.05).There was a significant difference in postoperative success rates among the three groups(χ^(2)=15.74,P<0.001).When compared pairwise between groups,the success rates of Group B and Group C were better than those of Group A(all P<0.05),while there was no significant difference in success rates between Group B and Group C(P>0.05).There was a significant difference in the postoperative cure rates among the three groups(χ^(2)=23.79,P<0.001).When compared pairwise between groups,the cure rate of Group C was better than that of Group A and Group B(all P<0.05),and Group B was better than Group A(P=0.004).Conclusions:Separation and non contact between the lacrimal sac flap and nasal mucosal flap during endoscopic endonasal dacryocystorhinostomy can effectively reduce the incidence of granulation tissue formation at the stoma postoperatively,making the formation of the stoma more perfect.At the same time,it improves the surgical efficacy and further reduces the patient's postoperative symptoms of epiphora.
作者
李沙
张咏
张将
Sha Li;Yong Zhang;Jiang Zhang(Aier Eye Hospital of Wuhan University,Wuhan 430000,China)
出处
《中华眼视光学与视觉科学杂志(中英文)》
北大核心
2025年第12期931-938,共8页
Chinese Journal Of Optometry Ophthalmology And Visual Science
关键词
肉芽组织
鼻内镜下泪囊鼻腔吻合术
吻合瓣
Munk评分
疗效
granulation tissue
endoscopic endonasal dacryocystorhinostomy
anastomotic flaps
Munk score
curative effect
