Tsirbas A, Wormald P J
Department of Ophthalmology, Flinders Medical Centre and Queen Elizabeth Hospital, Adelaide, South Australia.
Br J Ophthalmol. 2003 Jan;87(1):43-7. doi: 10.1136/bjo.87.1.43.
To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy (MENDCR). This is a new technique that involves creation of a large rhinostomy and mucosal flaps. The study involved a prospective non-randomised interventional case series with short perioperative follow up.
A prospective series of 104 consecutive endonasal DCRs performed from January 1999 to December 2001 were entered into the study. Patients included in the study had nasolacrimal duct obstruction and had not had previous lacrimal surgery. The technique involved anastomosis of nasal mucosal and lacrimal sac flaps and a large bony ostium. Surgery was performed by two surgeons (AT/PJW). Follow up assessment included nasoendoscopy as well as symptom evaluation. Success was defined as anatomical patency with fluorescein flow on nasoendoscopy and patency to lacrimal syringing. The average follow up time was 9.7 months (range 2-28, SD 6.7 months).
There were 104 DCRs performed on 86 patients (30 male, 56 female). The average age of the patients was 59 years (range 3-89, SD 24.1 years). Common presentations were epiphora (77%) and/or mucocele (19%). Septoplasty (SMR) was required in 48 DCRs (46%) and 13 DCRs (12.5%) needed other endoscopic surgery in conjunction with the lacrimal surgery. The surgery was successful in 93 cases (89%). Of the 11 cases that were classified as a failure six patients was anatomically patent but still symptomatic and another two had preoperative canalicular problems. The anatomical patency with this new technique was thus 95% (99 of 104 DCRs).
MENDCR involves creation of a large ostium and mucosal preservation for the construction of flaps. The anatomical success is 95% and is similar to external DCR and better then other endonasal approaches. The authors suggest that creation of a large ostium as well as mucosal flaps improves the efficacy of this endonasal technique.
描述并评估经鼻内镜泪囊鼻腔造口术（MENDCR）的疗效。这是一种新技术，包括创建一个大的鼻腔造口和黏膜瓣。本研究为前瞻性非随机干预病例系列，围手术期随访时间较短。
纳入1999年1月至2001年12月连续进行的104例经鼻内镜泪囊鼻腔造口术患者。纳入研究的患者患有鼻泪管阻塞且既往未接受过泪道手术。该技术包括鼻腔黏膜瓣与泪囊瓣的吻合以及一个大的骨孔。手术由两位外科医生（AT/PJW）进行。随访评估包括鼻内镜检查以及症状评估。成功定义为鼻内镜检查时荧光素通畅且泪道冲洗通畅的解剖学通畅。平均随访时间为9.7个月（范围2 - 28个月，标准差6.7个月）。
对86例患者（30例男性，56例女性）进行了104例泪囊鼻腔造口术。患者的平均年龄为59岁（范围3 - 89岁，标准差24.1岁）。常见表现为溢泪（77%）和/或黏液囊肿（19%）。48例泪囊鼻腔造口术（46%）需要鼻中隔成形术（SMR），13例泪囊鼻腔造口术（12.5%）需要与泪道手术联合进行其他内镜手术。手术成功93例（89%）。在11例被归类为失败的病例中，6例解剖学通畅但仍有症状，另外2例术前有泪小管问题。因此，这项新技术的解剖学通畅率为95%（104例泪囊鼻腔造口术中99例）。
经鼻内镜泪囊鼻腔造口术包括创建一个大的骨孔并保留黏膜以构建瓣膜。解剖学成功率为95%，与外路泪囊鼻腔造口术相似且优于其他经鼻入路。作者认为创建大的骨孔以及黏膜瓣可提高这种经鼻技术的疗效。
