鼻内镜下泪囊鼻腔造口术后吻合口狭窄。
Ostium shrinkage after endoscopic dacryocystorhinostomy.
机构信息
South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
出版信息
Ophthalmology. 2013 Aug;120(8):1693-6. doi: 10.1016/j.ophtha.2013.01.024. Epub 2013 May 1.
OBJECTIVE
Ostium closure after endoscopic dacryocystorhinostomy (DCR) is the commonest cause for anatomic failure. We aimed to determine the changes in size of the DCR ostium over time and investigate the correlation of ostium size and surgical outcomes.
DESIGN
A single surgeon, prospective, nonrandomized, noncomparative, interventional case series.
PARTICIPANTS
We included a consecutive series of patients who underwent powered endonasal DCR. All patients had radiologically confirmed nasolacrimal duct or canalicular obstruction.
METHODS
Patients were operated on by 1 surgeon (D.S.) and follow-up was at 4 weeks and 12 months. Ostium sizes were measured at the end of surgery and at 4 weeks and 12 months after surgery.
MAIN OUTCOME MEASURES
Intraoperative and postoperative ostium size, correlation of ostium size, and surgical outcome.
RESULTS
We included 161 patients who fulfilled the inclusion criteria. Three patients were lost to follow-up. The ostium measured 8.6 (95% confidence interval [CI], 5.0-12.2) by 13.4 (95% CI, 10.3-16.5) at the time of surgery and 5.7 (95% CI, 2.3-9.0) by 9.5 (95% CI, 6.0-13.0) at 4 weeks, and 4.8 (95% CI, 1.9-7.7) by 8.2 (95% CI, 4.5-11.9) at 12 months. There was significant ostial shrinkage from surgery to 4 weeks (mean shrinkage of 50%) and from 4 weeks to 12 months (mean shrinkage of a further 15%). The intraoperative ostium size and postoperative size were positively correlated. Ostial size was not predictive of final ostial patency and symptomatic resolution of epiphora.
CONCLUSIONS
After endoscopic DCR, the final ostium size on average is 35% of the original at 12 months postoperatively. The majority of the ostium shrinkage occurs within 4 weeks postoperatively with a lesser degree of shrinkage between 1 and 12 months postoperatively. Ostium size was not predictive of overall surgical outcome.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
目的
内镜下鼻内泪囊吻合术（DCR）后吻合口关闭是导致解剖失败的最常见原因。我们旨在确定吻合口大小随时间的变化，并研究吻合口大小与手术结果的相关性。
设计
单外科医生、前瞻性、非随机、非对照、干预性病例系列。
参与者
我们纳入了一系列连续接受电动鼻内 DCR 的患者。所有患者均经影像学证实存在鼻泪管或泪小管阻塞。
方法
由 1 名外科医生（D.S.）对患者进行手术，在术后 4 周和 12 个月进行随访。在手术结束时、术后 4 周和 12 个月测量吻合口大小。
主要观察指标
术中及术后吻合口大小、吻合口大小的相关性及手术结果。
结果
我们纳入了符合纳入标准的 161 例患者。3 例患者失访。手术时吻合口大小为 8.6（95%置信区间[CI]，5.0-12.2）×13.4（95%CI，10.3-16.5），术后 4 周时为 5.7（95%CI，2.3-9.0）×9.5（95%CI，6.0-13.0），术后 12 个月时为 4.8（95%CI，1.9-7.7）×8.2（95%CI，4.5-11.9）。从手术到 4 周吻合口明显缩小（平均缩小 50%），从 4 周到 12 个月进一步缩小 15%。术中吻合口大小与术后大小呈正相关。吻合口大小与最终吻合口通畅性和溢泪症状缓解无关。
结论
内镜下 DCR 后，12 个月时最终吻合口平均为原始大小的 35%。大多数吻合口缩小发生在术后 4 周内，术后 1 至 12 个月内吻合口缩小程度较小。吻合口大小与总体手术结果无关。
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