Liao S L, Kao S C, Tseng J H, Chen M S, Hou P K
Department of Ophthalmology National Taiwan University Hospital, 7, Chung-Shan S Road Taipei, Taiwan.
Br J Ophthalmol. 2000 Aug;84(8):903-6. doi: 10.1136/bjo.84.8.903.
To evaluate the long term results of intraoperative mitomycin C application in dacryocystorhinostomy (DCR) surgery compared with results of the conventional procedure.
In this prospective randomised controlled study, a total of 88 eyes diagnosed with acquired nasolacrimal duct obstruction were randomly divided into a conventional DCR group and a mitomycin C group in which mitomycin C was used during DCR surgery. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site for 30 minutes. The results of the DCR surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms by asking patients the condition of tearing improvement.
Among the 44 eyes in the mitomycin C group, 95.5% of patients remained totally symptom free after 10 months of follow up; while in the conventional group, 70.5% of patients were reported to be symptom free and 18% of patients to have an improvement in their symptoms. There was a significant difference between these two groups. As far as objective findings were concerned, there were 41 eyes in the mitomycin C group classified as having a normal and one eye with moderate tear meniscus level, compared with 32 eyes and seven eyes, respectively, in the conventional group. There was also a significant difference between these two groups. The non-patency rate in the mitomycin C group is 4.5% compared with 11.4% in the conventional group. There were no complications such as abnormal nasal bleeding, mucosal necrosis, or infection except one patient with delayed wound healing.
Intraoperative mitomycin C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.
评估泪囊鼻腔吻合术（DCR）中术中应用丝裂霉素C与传统手术方法相比的长期效果。
在这项前瞻性随机对照研究中，总共88只被诊断为获得性鼻泪管阻塞的眼睛被随机分为传统DCR组和丝裂霉素C组，后者在DCR手术中使用丝裂霉素C。两组的手术步骤完全相同，不同的是，丝裂霉素C组的患者中，一块浸泡有0.2mg/ml丝裂霉素C的神经外科棉片被应用于截骨部位30分钟。DCR手术的结果通过客观指标如冲洗和泪液弯月面高度进行评估，并通过询问患者流泪改善情况来评估主观症状。
在丝裂霉素C组的44只眼中，95.5%的患者在随访10个月后完全无症状；而在传统组中，70.5%的患者被报告无症状，18%的患者症状有所改善。两组之间存在显著差异。就客观指标而言，丝裂霉素C组有41只眼被分类为正常，1只眼泪液弯月面水平中等，而传统组分别为32只眼和7只眼。两组之间也存在显著差异。丝裂霉素C组的未通畅率为4.5%，而传统组为11.4%。除1例伤口愈合延迟的患者外，未出现鼻出血异常、黏膜坏死或感染等并发症。
术中应用丝裂霉素C可有效提高标准鼻泪管阻塞DCR手术的成功率，且使用该药物未导致明显并发症。
