Western Eye Hospital, London, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2009 Nov-Dec;25(6):472-5. doi: 10.1097/IOP.0b013e3181b81e9f.
To present the results of external dacryocystorhinostomy (ext-DCR) for epiphora using strict outcome criteria and provide an accurate baseline and evidence from which to compare the results of endonasal dacryocystorhinostomy.
Retrospective case notes review of 158 consecutive adult patients who underwent primary ext-DCR. Functional success was assessed according to the patients' symptoms and anatomical success was measured using objective tests of lacrimal system patency: 1) the functional endoscopic dye test and/or endoscopic endonasal inspection of the ostium; 2) syringing of the lacrimal system; and 3) the fluorescein dye retention test. Patients without complete follow-up data were recalled for clinical reevaluation. A minimum follow-up of 6 months was required. Comparison of overall functional and anatomical success was further analyzed according to etiology using logistic regression and for different grades of surgeon using the chi-squared test.
The results for 124 of 158 ext-DCRs showed an overall functional success of 69% and anatomical success of 74%. Patients with primary acquired nasolacrimal duct obstruction (PANDO) who had surgery by the specialist lacrimal surgeon had high success: 83% functional success and 100% anatomical success. Patients with watering eyes from non-PANDO aetiology including canalicular disease who had surgery by the specialist lacrimal surgeon had moderate success: 78% functional success and 70% anatomical success. The results of all surgery by trainees were lower but only significantly so for PANDO. The mean duration of follow-up was 2.6 years (range, 6 months to 8.3 years); median follow-up was 1.9 years.
This study used strict criteria to assess functional and anatomical outcomes of primary ext-DCR and thus provide baseline measures of success with a minimal follow-up of 6 months. When canalicular disease was excluded, results for PANDO were higher. Surgery performed by the specialist lacrimal surgeon had higher success rates than when performed by trainee.
使用严格的结果标准呈现外鼻内囊吻合术（ext-DCR）治疗溢泪的结果，并提供准确的基线和证据，以便比较鼻内囊吻合术的结果。
回顾性分析 158 例成人原发性 ext-DCR 连续患者的病历。根据患者的症状评估功能成功，使用泪道通畅性的客观测试测量解剖成功：1）功能性内镜染料试验和/或鼻内内镜检查吻合口；2）泪道冲洗；3）荧光素染料保留试验。对没有完整随访数据的患者进行临床重新评估。需要至少 6 个月的随访。使用逻辑回归分析根据病因进一步分析总体功能和解剖成功率，使用卡方检验分析不同等级的外科医生。
158 例 ext-DCR 中有 124 例的结果显示总功能成功率为 69%，解剖成功率为 74%。由专业泪腺外科医生进行手术的原发性获得性鼻泪管阻塞（PANDO）患者成功率较高：83%的功能成功率和 100%的解剖成功率。由专业泪腺外科医生进行手术的非 PANDO 病因引起的溢泪患者成功率中等：78%的功能成功率和 70%的解剖成功率。受训者进行的所有手术的结果较低，但 PANDO 的结果显著较低。平均随访时间为 2.6 年（范围，6 个月至 8.3 年）；中位数随访时间为 1.9 年。
本研究使用严格的标准评估原发性 ext-DCR 的功能和解剖结果，因此提供了 6 个月最小随访的成功基准测量。当排除了泪小管疾病时，PANDO 的结果更高。由专业泪腺外科医生进行的手术比由受训者进行的手术成功率更高。
