纳吸棉鼻腔填塞对内镜下泪囊鼻腔吻合术的影响

Effect of Nasopore nasal packing on endoscopic dacryocystorhinostomy

摘要:

目的：探讨在吻合口周围放置可吸收材料纳吸棉对内镜下泪囊鼻腔吻合术(En-DCR)术后再出血、不适感及成功率的影响。

方法：前瞻性随机对照研究。收集2020-11/2021-10在湖北医药学院附属人民医院眼科就诊且诊断为慢性泪囊炎并进行En-DCR手术的成年患者101例101眼，随机分成两组：填塞组49眼手术结束时用修剪后的可吸收材料纳吸棉填塞在吻合口周边鼻腔，非填塞组52眼术后则不做处理。术后随访9 mo，比较两组患者术后再出血情况、鼻腔舒适度及术后成功率(包括解剖成功率和功能成功率)。

结果：所有患者均顺利完成常规En-DCR手术。填塞组4眼，非填塞组3眼术后未完成随访，最终共纳入患者94例94眼，其中填塞组45例45眼，非填塞组49例49眼。术后解剖成功率填塞组为93%(42/45)、非填塞组为88%(43/49)(P>0.05)； 术后功能成功率：填塞组为89%(40/45)、非填塞组为86%(42/49)(P>0.05)。填塞组1眼(2%)，非填塞组9眼(18%)术后发生再出血情况(P<0.05)。填塞组2例(4%)，非填塞组9例(18%)术后鼻腔不适(P<0.05)。所有患者均未出现眼眶脂肪脱垂、脑脊液漏、鼻窦炎、视力损害、视物重影等其他并发症。

结论：En-DCR手术结束时鼻腔填塞可吸收材料纳吸棉可减少术后再出血及患者术后不适感，对术后成功率无明显影响。

Abstract:

AIM: To investigate the effects of placement of the absorbable packing material Nasopore around the anastomosis site on postoperative re-bleeding, discomfort, and on the success rate of endoscopic dacryocystorhinostomy(En-DCR).

METHODS: Prospective randomized controlled study. A total of 101 patients(101 eyes)diagnosed with chronic dacryocystitis that underwent En-DCR in the ophthalmology department, Renmin Hospital, Hubei University of Medicine from November 2020 to October 2021 were collected. The patients were randomly divided into two groups according to whether they were packed with Nasopore at the end of operation, namely, the packed group(49 eyes)and the non-packed group(52 eyes). The postoperative follow-up was 9 mo, the degree of re-bleeding, discomfort, and postoperative success rate(including anatomical success rate and functional success rate)were compared between the two groups of patients.

RESULTS: This study included 94 patients, including 45(45 eyes)and 49(49 eyes)in packed group and non-packed group, respectively. The En-DCR was performed successfully in all patients. Postoperative re-bleeding occurred in 1 eye(2%)in the packed group, and 9 eyes(18%)in the non-packed group(P<0.05); postoperative nasal discomfort occurred in 2 cases(4%)in the packed group, and 9 cases(18%)in the non-packed group(P<0.05); The success rate of postoperative anatomical success rate was 93%(42/45)in the packed group and 88%(43/49)in the non-packed group(P>0.05). The postoperative functional success rate was 89%(40/45)in the packed group and 86%(42/49)in the non-packed group(P>0.05). Other complications such as orbital fat prolapse, cerebrospinal fluid leakage, sinusitis, visual impairment and double vision were not observed in all patients during the follow-up.

CONCLUSION: Nasal packing absorbable material Nasopore around the anastomosis at the end of En-DCR operation can reduce postoperative re-bleeding and postoperative discomfort of patients, and it has no obvious effect on the postoperative success rate.