Otorhinolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile.
Laryngoscope. 2010 Jul;120(7):1449-52. doi: 10.1002/lary.20916.
OBJECTIVES/HYPOTHESIS: To compare surgical outcomes of primary powered endoscopic dacryocystorhinostomy (DCR) with selective or routine silicone stenting in anatomic and functional nasolacrimal duct obstruction (NLDO).
Prospective nonrandomized cohort study with historical control group.
Thirty-one consecutive primary powered endoscopic DCR procedures with selective stenting were performed for anatomic or functional NLDO. No stenting was used unless a tight Rosenmuller valve was appreciated when probing nasolacrimal system during surgery. Nasolacrimal system irrigation, dacryocystography, and lacrimal scintigraphy were used for preoperative assessment. Success was defined as absence of symptoms and patent nasolacrimal system. Comparisons were made with a historical cohort of 31 consecutive primary powered endoscopic DCR procedures with routine stenting.
The overall success rate was 79% (49/62), with 96.3% (26/27) success for anatomic and 65.7% (23/35) for functional NLDO. Success rates for anatomic NLDO were 100% (8/8) with selective stenting and 94.7% (18/19) with routine stenting (P > .05). Success rates for functional NLDO were 60.9% (14/23) with selective stenting and 75% (9/12) with routine stenting (P > .05). In the selective stenting group, 2/8 of the anatomic obstructions and 8/23 of the functional obstructions required stents.
Our study suggests that there is no difference in surgical outcomes of primary powered endoscopic DCR with selective or routine stenting in both anatomic and functional NLDO. We advocate a selective stenting approach for primary endoscopic DCR, whereby stents are only inserted when a tight common canaliculus opening is found during surgery.
目的/假设：比较原发性动力内镜下鼻内泪囊吻合术（DCR）在解剖学和功能性鼻泪管阻塞（NLDO）中选择性或常规硅胶支架置入的手术效果。
前瞻性非随机队列研究，有历史对照组。
对 31 例原发性动力内镜下 DCR 行选择性支架置入术治疗解剖学或功能性 NLDO。只有在术中探查鼻泪管系统时发现泪小管开口狭窄时才使用支架，否则不使用支架。术前评估采用泪道冲洗、泪囊造影和泪液闪烁显像。成功定义为无症状和鼻泪管通畅。与 31 例原发性动力内镜下 DCR 常规支架置入术的历史队列进行比较。
总成功率为 79%（49/62），解剖学成功率为 96.3%（26/27），功能性成功率为 65.7%（23/35）。选择性支架置入的解剖学 NLDO 成功率为 100%（8/8），常规支架置入的成功率为 94.7%（18/19）（P >.05）。选择性支架置入的功能性 NLDO 成功率为 60.9%（14/23），常规支架置入的成功率为 75%（9/12）（P >.05）。在选择性支架置入组中，8 例解剖学阻塞中有 2 例和 23 例功能性阻塞中有 8 例需要支架。
我们的研究表明，原发性动力内镜下 DCR 选择性或常规支架置入在解剖学和功能性 NLDO 中的手术效果无差异。我们主张对原发性内镜 DCR 采用选择性支架置入方法，只有在术中发现泪小管开口狭窄时才插入支架。
