Keerl R, Weber R
Chefarzt der Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-, Hals- und plastische Gesichtschirurgie, Klinikum St. Elisabeth, 94315 Straubing.
Laryngorhinootologie. 2004 Jan;83(1):40-50. doi: 10.1055/s-2004-814110.
In the ophthalmological literature external dacryocystorhinostomy (DCR) is considered the gold standard for the treatment of lacrimal duct stenoses. Rhinologists, on the other hand, favour the endonasal approach.
On the basis of an extensive review of the literature and our own longstanding experience we present an overview of the causes, the necessary diagnostic procedures and the surgical management of lacrimal duct stenosis. The outcomes of the two operative approaches are compared and special operative techniques and aids such as the use of laser, endoscopic dacryoplasty, silicone stenting, silicone cones with lacrimal duct stenting and the use of mitomycin C are discussed.
The results published for endonasal DCR are slightly worse than those for the external operation. The success rates are around 90 %. Laser-assisted DCR and endoscopic dacryoplasty do not currently appear to yield better results than the conventional methods. Silicone stenting is not necessary in conventional endonasal DCR except in the case of presaccal stenosis. There are no established indications or treatment regimens for mitomycin C to date. Postoperative care after endonasal DCR should consist in the removal of fibrin, crusts and granulations and the administration of eye drops (antibiotic + cortisone) and nasal steroids.
With appropriate operative technique and in experienced hands, the success rates of endonasal DCR are practically equal to those of the classical external approach. Major advantages of the endonasal approach are shorter operation times, lower complication rates and reduced patient morbidity. Neither silicone stenting nor the application of mitomycin C are routinely indicated. Laser-assisted techniques do not currently appear to improve results. Appropriate postoperative care is essential to prevent endonasal synechiae and subsequent recurrences.
在眼科文献中，外路泪囊鼻腔吻合术（DCR）被视为治疗泪道狭窄的金标准。另一方面，鼻科医生则倾向于鼻内入路。
基于对文献的广泛回顾以及我们自身长期的经验，我们对泪道狭窄的病因、必要的诊断程序和手术治疗进行了概述。比较了两种手术入路的结果，并讨论了特殊的手术技术和辅助手段，如激光的使用、内镜下泪道成形术、硅胶支架置入、带泪道支架的硅胶管以及丝裂霉素C的使用。
鼻内DCR公布的结果略逊于外路手术。成功率约为90%。目前，激光辅助DCR和内镜下泪道成形术似乎并未比传统方法产生更好的效果。在传统鼻内DCR中，除泪囊前狭窄外，通常无需硅胶支架置入。迄今为止，丝裂霉素C尚无既定的适应证或治疗方案。鼻内DCR术后护理应包括清除纤维蛋白、痂皮和肉芽组织，并给予眼药水（抗生素+可的松）和鼻用类固醇。
采用适当的手术技术且由经验丰富的医生操作时，鼻内DCR的成功率实际上与经典外路手术相当。鼻内入路的主要优点是手术时间短、并发症发生率低以及患者发病率降低。硅胶支架置入和丝裂霉素C的应用均非常规适应证。目前，激光辅助技术似乎并未改善手术效果。适当的术后护理对于预防鼻内粘连及随后的复发至关重要。
