Massegur Humbert, Trias Enric, Ademà Juan Manuel
ENT Department, Hospital de la Sta Creu i Sant Pau, Barcelona, Spain.
Otolaryngol Head Neck Surg. 2004 Jan;130(1):39-46. doi: 10.1016/j.otohns.2003.08.011.
Dacryocystorhinostomy (DCR) is a surgical technique that has been increasingly used by otolaryngologists in recent years due to the improved endonasal approach with endoscopes. Although it was first described in 1893 by Caldwell, it has been performed by ophthalmologists.
Even though permeability results are similar in long-term follow-up, we present some modifications that in our opinion contribute to the improvement of the results and the simplification of the surgical technique: mucosal flap design that helps to improve the postoperative mucosal recovery, careful dissection of the bony suture between the frontal process of the maxillary bone and the lacrimal bone, and osteotomy using a Smith-Kerrison forceps.
Two groups are compared. In the first group (96 DCRs), patients underwent chisel osteotomies without a mucosal flap of the lacrimal duct, and in the second group (40 DCRs), the modified technique was applied.
Final permeability results are similar (92.7% versus 87.5%). No major complications were found, and the most common minor complication was postoperative eyelid hematoma in cases where orbital fat was exposed (5 cases versus 7 cases).
There are no differences in final results, but the modified technique is easier to perform, improves postoperative mucosal recovery, is more functional and less aggressive, and improves the cost-benefit ratio.
泪囊鼻腔造口术（DCR）是一种外科手术技术，近年来由于鼻内镜下鼻内入路的改进，越来越多地被耳鼻喉科医生采用。尽管它最早于1893年由考德威尔描述，但一直由眼科医生进行操作。
尽管长期随访中通畅结果相似，但我们提出了一些改进措施，我们认为这些措施有助于改善结果并简化手术技术：有助于改善术后黏膜恢复的黏膜瓣设计、对上颌骨额突与泪骨之间骨缝的仔细解剖以及使用史密斯-凯利森咬骨钳进行截骨术。
比较两组。第一组（96例泪囊鼻腔造口术）患者接受了不做泪道黏膜瓣的凿骨术，第二组（40例泪囊鼻腔造口术）应用了改良技术。
最终通畅结果相似（92.7%对87.5%）。未发现重大并发症，最常见的轻微并发症是在暴露眶脂肪的病例中出现术后眼睑血肿（5例对7例）。
最终结果无差异，但改良技术操作更简便，可改善术后黏膜恢复，功能更强且侵袭性更小，还提高了成本效益比。
