Delaney Y M, Khooshabeh R
Department of Ophthalmology, John Radcliffe Hospitals NHS Trust, Oxford OX2 6HE, UK.
Br J Ophthalmol. 2002 May;86(5):533-5. doi: 10.1136/bjo.86.5.533.
To determine the long term success of external dacryocystorhinostomy (DCR) in adults with acquired partial nasolacrimal obstruction.
A retrospective study of 50 external dacryocystorhinostomies with silicone intubation performed for partial nasolacrimal obstruction, was undertaken. Preoperative lacrimal scintigraphy divided drainage abnormalities into presac or postsac delays. Postoperative success was determined by lacrimal patency to irrigation, a positive dye test on nasal endoscopy and subjective resolution of epiphora. Statistical analysis was performed using the Fisher exact test.
A patent DCR system to irrigation and a positive dye test was achieved in 90% of procedures. At an average of 3.6 months' follow up, subjective success was reported in 84% of cases-91% for postsac and 67% for presac delays. At 3 years' follow up success had declined to 70% overall and to 80% and 47% for postsac and presac occlusions respectively. There was a statistically significant association between a presac delay and postoperative recurrence of epiphora, p = 0.04.
External DCR with silicone intubation is an effective procedure for partial nasolacrimal obstruction. Presac delays do significantly less well and further studies are necessary to evaluate the best type of surgery for these patients.
确定成人后天性部分鼻泪管阻塞行外置泪囊鼻腔造口术（DCR）的长期成功率。
对50例行硅胶插管的外置泪囊鼻腔造口术治疗部分鼻泪管阻塞患者进行回顾性研究。术前泪道闪烁造影将引流异常分为泪囊前或泪囊后延迟。术后成功的判定标准为冲洗泪道通畅、鼻内镜检查染料试验阳性及溢泪主观症状缓解。采用Fisher精确检验进行统计学分析。
90%的手术实现了冲洗泪道通畅及染料试验阳性的DCR系统。平均随访3.6个月时，84%的病例获得主观成功——泪囊后延迟者为91%，泪囊前延迟者为67%。随访3年时，总体成功率降至70%，泪囊后阻塞和泪囊前阻塞者分别降至80%和47%。泪囊前延迟与术后溢泪复发之间存在统计学显著关联，p = 0.04。
硅胶插管外置DCR是治疗部分鼻泪管阻塞的有效方法。泪囊前延迟效果明显较差，有必要进一步研究以评估这类患者的最佳手术方式。
