Rathore P K, Kumari Sodhi Punita, Pandey R M
Professor of Ear Nose Throat Specialties, Maulana Azad Medical College, New Delhi, India.
Orbit. 2009;28(5):297-302. doi: 10.3109/01676830902856328.
Unusual intranasal conditions may increase the rate of complications and affect success rate of endonasal dacryocystorhinostomy (DCR) surgery. The purpose of this study was to find the influence of endonasal abnormalities on outcome of endonasal DCR surgery and to find the role of topical mitomycin C (MMC) as a postoperative adjunct to endonasal dacryocystorhinostomy in these patients.
A total of 23 patients (19 males and 4 females) of bilateral chronic dacryocystitis in the age range of 18-60 years, having endonasal anatomical variants were included in this study. After endonasal DCR, the right side of nasal cavity was packed with 0.05% MMC nasal pack and left side of nasal cavity was packed with normal saline pack for 48 hours. During postoperative visits, the patients were checked for improvement in clinical symptoms and watched for complications including formation of adhesions and/or synechaie. The statistical association between endonasal pathologies and 3 dichotomous outcome variables (clinical features, adhesions, synechaie) was assessed by applying Fisher's Exact Test.
Postoperative retention of nasal packs for 48 hours after endonasal DCR, did not cause any side effect in our patients. An improvement in clinical symptoms (23/23 = 100%) was seen in all the patients on side with 0.05% MMC soaked nasal pack, while 10/23 i.e., 43.47% patients did not show improvement in symptoms on side of saline nasal pack. Postoperatively, the MMC nasal pack side nasal cavity had a healthy nasal mucosa during the entire follow up, while the saline nasal pack side nasal cavity had synechiae in 15/23 (65.2%) patients and adhesions in 15/23 (65.2%) patients. In our study, none of the anatomical endonasal variants had a statistically significant association with either formation of adhesion or formation of synechiae, as the p-value was > 0.05 in all these instances.
The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.
异常的鼻内情况可能会增加并发症发生率并影响鼻内镜下泪囊鼻腔造口术（DCR）的成功率。本研究的目的是探讨鼻内异常对鼻内镜下DCR手术结果的影响，并确定局部应用丝裂霉素C（MMC）作为这些患者鼻内镜下泪囊鼻腔造口术后辅助治疗的作用。
本研究纳入了23例年龄在18至60岁之间、患有双侧慢性泪囊炎且存在鼻内解剖变异的患者（19例男性和4例女性）。鼻内镜下DCR术后，右侧鼻腔用0.05% MMC鼻填塞物填塞，左侧鼻腔用生理盐水填塞物填塞48小时。术后随访期间，检查患者临床症状的改善情况，并观察并发症，包括粘连和/或粘连形成。通过应用Fisher精确检验评估鼻内病变与3个二分结局变量（临床特征、粘连、粘连形成）之间的统计学关联。
鼻内镜下DCR术后鼻填塞物保留48小时，在我们的患者中未引起任何副作用。在所有使用0.05% MMC浸泡鼻填塞物的一侧，患者的临床症状均有改善（23/23 = 100%），而在使用生理盐水鼻填塞物一侧，10/23即43.47%的患者症状未改善。术后，MMC鼻填塞物一侧的鼻腔在整个随访期间鼻黏膜健康，而生理盐水鼻填塞物一侧的鼻腔在15/23（65.2%）的患者中出现粘连，在15/23（65.2%）的患者中出现粘连。在我们的研究中，没有一种鼻内解剖变异与粘连形成或粘连形成有统计学显著关联，因为在所有这些情况下p值均>0.05。
与其他患者相比，存在鼻内解剖变异的患者在鼻内镜下DCR术后发生粘连和粘连等并发症的发生率更高。局部应用MMC作为鼻内解剖变异患者鼻内镜下DCR的辅助治疗，是一种安全有效的降低并发症发生率的药物。
