Orcutt J C, Hillel A, Weymuller E A
Department of Ophthalmology and Otolaryngology, University of Washington, Seattle 98195.
Ophthalmic Plast Reconstr Surg. 1990;6(3):197-202. doi: 10.1097/00002341-199009000-00009.
Primary dacryocystorhinostomy (DCR) failure is commonly due to scarring at the rhinostomy site. Nasolacrimal duct obstruction due to scarring may also occur in patients who have had their lacrimal bone removed during maxillary sinus surgery. Five patients following DCR and 3 patients after sinus surgery, all with constant epiphora, underwent endoscopic reconstruction of their lacrimal drainage system. Preoperatively, patency of the bony ostium was determined either by computed tomographic (CT) scan or dacryocystography. Endoscopically, the lacrimal drainage system was reopened then intubated with a silastic stent. Any scar tissue was visualized endoscopically and resected. Seven of the 8 patients have been followed from 3 to 24 months after stent removal, and all have had relief of their epiphora. Endoscopic repair is a useful adjunct in the management of patients with DCR failure or patients with epiphora after removal of the lacrimal bone during sinus surgery. This brief procedure can be performed under local anesthesia, does not require a skin incision, and allows the evaluation and correction of intranasal pathology.
原发性泪囊鼻腔吻合术（DCR）失败通常是由于鼻造口部位的瘢痕形成。在上颌窦手术中切除泪骨的患者也可能发生因瘢痕形成导致的鼻泪管阻塞。5例接受DCR手术后的患者和3例鼻窦手术后的患者，均有持续性溢泪症状，接受了泪道引流系统的内镜重建。术前，通过计算机断层扫描（CT）或泪囊造影确定骨性开口的通畅情况。在内镜下，重新开放泪道引流系统，然后插入硅橡胶支架。在内镜下观察并切除任何瘢痕组织。8例患者中有7例在取出支架后3至24个月接受了随访，所有患者的溢泪症状均得到缓解。内镜修复对于DCR失败的患者或鼻窦手术中切除泪骨后出现溢泪的患者是一种有用的辅助治疗方法。这个简短的手术可以在局部麻醉下进行，不需要皮肤切口，并且可以评估和纠正鼻腔内的病变。
