纳吸棉在内镜下鼻腔泪囊吻合术中的应用
发布时间：2018-08-27 06:59
【摘要】：目的:本研究将纳吸棉(Nasopore)用于内镜下鼻腔泪囊吻合术(Endoscopical transnasal dacryocystorhinostomy,Et-DCR)中填充并支撑泪囊造瘘口,观察其对慢性泪囊炎术后疗效的影响。方法:收集河北医科大学第二医院眼科2015年8月至2016年8月期间收治的慢性泪囊炎患者80例(81眼)。所有入选的患者术前行全面的眼科检查、泪道冲洗检查、泪囊造影检查和鼻腔检查。按照造瘘口处是否填充纳吸棉分为A、B两组,A组50例(51眼),行内镜下鼻腔泪囊吻合术,造瘘口处填充纳吸棉,黏膜瓣对合处及骨质暴露部位覆盖纳吸棉,女42例(43眼),男8例(8眼),右眼29只,左眼22只,平均年龄51.04±2.04岁,平均病程7.22±0.53年,泪囊平均大小为:0.51±0.03cm3;B组30例(30眼),行内镜下鼻腔泪囊吻合术,仅黏膜瓣对合处及骨质暴露部位覆盖纳吸棉,而造瘘口处不填充纳吸棉,女24例(24眼),男6例(6眼),右眼18只,左眼12只,平均年龄46.67±2.79岁,平均病程5.87±0.59年,泪囊平均大小为:0.52±0.05cm3。泪囊大小是通过CT泪囊造影计算,计算机测量软件测量泪囊的水平径、垂直径及矢状径,最终泪囊大小=水平径×垂直径×矢状径,观察两组在性别、眼别、年龄、病程、泪囊大小方面差异是否有统计学意义。分别于术后1个月、3个月、6个月行内镜检查,i观察患者有无溢泪、流脓症状,ii冲泪道是否通畅,iii内镜下观察吻合口是否开放,将以上三项作为评判术后泪道重建是否成功的标准,比较两组术后1个月、3个月、6个月时泪道重建的成功率及肉芽增生和/或瘢痕形成率。结果:本次研究共80例患者81眼,其中A组50例51眼,B组30例30眼。两组在年龄、性别、眼别、病程、泪囊大小方面均无统计学差异(P0.05)。分别于术后1个月、3个月、6个月行内镜检查。1泪道重建成功率的比较:术后1月:A组泪道重建成功50例51眼(51/51,100.0%),B组泪道重建成功25例25眼(25/30,83.3%),两组比较差异有统计学意义(χ2=6.410 P=0.011)。术后3月:A组手术成功49例50眼(50/51,98.0%),B组手术成功23例23眼(23/30,76.7%),两组比较差异有统计学意义(χ2=7.441 P=0.006)。术后6月:A组手术成功48例49眼(49/51,96.1%),B组手术成功21例21眼(21/30,70.0%),两组比较差异有统计学意义(χ2=8.837 P=0.003)2吻合口处肉芽增生和/或瘢痕形成率的比较:术后1个月:A组吻合口处肉芽增生2例2眼,尚未影响吻合口的开放;B组5例5眼均因吻合口处肉芽过度增生导致吻合口闭锁。术后3个月:A组共4例4眼吻合口处肉芽增生,其中1例1眼因吻合口处肉芽过度增生导致吻合口闭锁,3例3眼尚未影响吻合口的开放;B组共9例9眼吻合口处肉芽增生,其中7例7眼因肉芽过度增生导致吻合口闭锁,2例2眼尚未影响吻合口的开放。术后6个月:A组共4例4眼吻合口处瘢痕形成,其中2例2眼未影响吻合口的开放,2例2眼瘢痕形成,吻合口闭锁;B组共9例9眼吻合口处瘢痕形成,吻合口闭锁。A组中吻合口处肉芽增生和/或瘢痕形成共4例4眼(4/51,7.8%),B组中吻合口处肉芽增生和/或瘢痕形成共9例9眼(9/30,30.0%),两组差异有统计学意义(χ2=5.336,P=0.021)。结论:在内镜下鼻腔泪囊吻合术中,纳吸棉可有效地支撑造瘘口,并可抑制肉芽增生和瘢痕形成,从而保持吻合口的开放,提高手术成功率,值得在临床上推广利用。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2206478
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
【参考文献】
相关期刊论文 前10条
1 张忠红;;慢性泪囊炎是潜伏的“定时炸弹”[J];祝您健康;2017年01期
2 赵卡卡;王望晓;蔡晓红;;微小瘢痕外路泪囊鼻腔吻合术16例[J];中国眼耳鼻喉科杂志;2016年05期
3 王羽琦;张熙伯;余玲;;泪道激光与高频电灼联合不同类型引流管植入治疗鼻泪管阻塞的疗效观察[J];医学理论与实践;2016年12期
4 年金瑞;李艳霞;;182例泪囊炎患者细菌培养及药敏结果分析[J];国际医药卫生导报;2016年13期
5 李宏宇;;泪囊炎患者的临床治疗分析[J];中国继续医学教育;2016年14期
6 高英;刘涛;;慢性泪囊炎的手术选择进展[J];山西医药杂志;2016年03期
7 宋东霞;朱安泰;;硅胶泪囊支架术治疗慢性泪囊炎[J];包头医学院学报;2016年02期
8 张宝根;;鼻窦内窥镜下泪囊鼻腔造孔术治疗慢性泪囊炎临床观察[J];中国现代药物应用;2016年02期
9 刘艳丽;赵堪兴;于建国;齐世欣;贺玮;常翠荣;;慢性泪囊炎感染患者的病原菌与药敏分析[J];中华医院感染学杂志;2016年04期
10 金晶;项楠;刘荣;胡维琨;;泪道内窥镜在观察患者泪道黏膜及阻塞部位中的应用[J];国际眼科杂志;2016年01期
，本文编号：2206478
本文链接：https://www.wllwen.com/yixuelunwen/wuguanyixuelunwen/2206478.html
最近更新
教材专著
