Department of Otorhinolaryngology, Kuopio University Hospital, Finland.
Acta Ophthalmol. 2011 Mar;89(2):e132-6. doi: 10.1111/j.1755-3768.2009.01654.x.
Dacryocystorhinostomy (DCR) is an effective and safe procedure for patients with post-saccal obstruction of the nasolacrimal pathway. The aim of DCR is to relieve symptoms by creating a bypass between the lacrimal sac and the nasal cavity. The most common reason for failure is stenosis caused by a fibrotic process at the rhinostomy site. In this prospective study we assessed the expression of heat shock protein 47 (HSP47), a regulator of fibrosis, in the biopsies of nasal mucosa isolated from patients undergoing primary endoscopic DCR (EN-DCR).
Thirty consecutive primary EN-DCR procedures in 30 patients were performed using the powered instrumentation technique. The nasal mucosa specimens over the rhinostomy site were collected for histological analysis at the beginning of the operation and the expression of HSP47 was evaluated by immunohistochemistry. The outcome of EN-DCR was estimated in follow-up visits at 1 week, 2 months and 6 months after surgery.
At the 6-month follow-up, the overall success rate after primary EN-DCR was 83%. A metaplastic change and strong expression of HSP47 in nasal mucosa were associated with EN-DCR failure (p = 0.009).
HSP47 may be regarded as a novel marker to predict impaired EN-DCR outcome.
鼻内泪囊吻合术（DCR）是治疗鼻泪管后囊阻塞的有效且安全的方法。DCR 的目的是通过在泪囊和鼻腔之间建立旁路来缓解症状。失败的最常见原因是吻合口处的纤维性过程引起的狭窄。在这项前瞻性研究中，我们评估了热休克蛋白 47（HSP47）在接受初次内镜下鼻内泪囊吻合术（EN-DCR）的患者的鼻黏膜活检中的表达。
对 30 例患者的 30 例连续初次 EN-DCR 手术采用动力器械技术进行。在手术开始时收集吻合口处的鼻黏膜标本进行组织学分析，并通过免疫组织化学评估 HSP47 的表达。在手术后 1 周、2 个月和 6 个月的随访中评估 EN-DCR 的结果。
初次 EN-DCR 后的 6 个月总体成功率为 83%。黏膜的化生改变和 HSP47 的强表达与 EN-DCR 失败相关（p=0.009）。
HSP47 可作为预测 EN-DCR 结果受损的新型标志物。
