Hii Belinda W, McNab Alan A, Friebel Justin D
Department of Ophthalmology, Alfred Hospital, Prahran, Australia.
Orbit. 2012 Apr;31(2):67-76. doi: 10.3109/01676830.2011.648803.
Definitive treatment of nasolacrimal duct obstruction is with external or endonasal dacryocystorhinostomy (DCR). Recent trials suggest surgical equivalency between techniques. We sought to compare alternative outcomes of DCR techniques in terms of quality of life and cost.
This study was a multicentre prospective nonrandomized case series comparing adult patients treated with external or endonasal DCR. Groups were allocated according to DCR technique. Participation did not affect treatment choice. The Glasgow Benefit Inventory (GBI) was utilized to compare postoperative quality of life, and an activity-based costing (ABC) method used to estimate costs of the two techniques. Surgical data were also collected. A minimum of 3 months follow-up was observed.
Seventy-seven patients were included--37 external and 40 endonasal. Both techniques resulted in positive health status change, with mean GBI scores of +16.1 for external DCR and +24.1 for endonasal (p = 0.18). Using an ABC method, the operative costs of external DCR were less than endonasal at $715.79 AUD and $932.52 AUD respectively.
This trial suggests that external and endonasal DCR produce comparable outcomes in terms of postoperative quality of life, with external DCR resulting in lower operative costs.
鼻泪管阻塞的确定性治疗方法是外路或鼻内镜下泪囊鼻腔造口术（DCR）。近期试验表明两种技术在手术效果上相当。我们试图比较DCR技术在生活质量和成本方面的其他结果。
本研究是一项多中心前瞻性非随机病例系列研究，比较接受外路或鼻内镜下DCR治疗的成年患者。根据DCR技术对患者进行分组。参与研究不影响治疗选择。采用格拉斯哥效益量表（GBI）比较术后生活质量，并使用作业成本法（ABC）估算两种技术的成本。同时收集手术数据。观察期至少为3个月。
共纳入77例患者，其中37例行外路DCR，40例行鼻内镜下DCR。两种技术均使健康状况得到改善，外路DCR的平均GBI评分为+16.1，鼻内镜下DCR为+24.1（p = 0.18）。采用ABC法，外路DCR的手术成本低于鼻内镜下DCR，分别为715.79澳元和932.52澳元。
本试验表明，外路和鼻内镜下DCR在术后生活质量方面产生的结果相当，外路DCR的手术成本更低。
