Taşkıran Çömez Arzu, Karadağ Onur, Arıkan Sedat, Gencer Baran, Kara Selçuk
Department of Ophthalmology, Canakkale Onsekiz Mart University, School of Medicine, 17020, Çanakkale, Turkey.
Lasers Surg Med. 2014 Apr;46(4):275-80. doi: 10.1002/lsm.22236. Epub 2014 Feb 26.
To compare the success, complication, and patient discomfort rates of transcanalicular diode laser dacryocystorhinostomy (TCDL-DCR) and external dacryocystorhinostomy (EX-DCR) surgeries performed in patients with primary acquired nasolacrimal duct obstruction.
Eighty consecutive patients were included in the study, and groups were assigned according to DCR technique. Thirty-four (42.5%) patients received TCDL-DCR (Group A) and 46 (57.5%) patients (Group B) received EX-DCR with temporary silicone stent intubation. The success of surgery was determined by the relief of epiphora, patient satisfaction, endoscopic evaluation of ostium patency, and lacrimal system syringing. Pearson Chi-Square test, Fisher's Exact test, and Student's t-test were used for statistical analyses.
Group A included 22 females and 12 males with a mean age of 49.1 ± 15.1 years, Group B included 35 females and 11 males with a mean age of 50.8 ± 11.7 years. There was no difference between groups in terms of age and gender (P = 0.905 and P = 0.167, respectively). The duration of the operation was 22.2 ± 4.8 minutes for Group A, while it was 56.3 ± 15.7 minutes for group B (P = 0.0001). In two patients in Group A, injury in the medial turbinate was recorded, and in Group B, 14 patients experienced mild to severe perioperative bleeding. The perioperative complication rate was significantly different between the groups (P = 0.004). Success in relieving symptoms was 79.4% for Group A and 89.1% for Group B. The difference in the success rates was not statistically significant (P = 0.229).
Although EX-DCR success rate was higher than that achieved with TCDL-DCR, the latter, with its shorter duration of surgery, lower perioperative complication rate, and a similar success rate, may be a good and acceptable surgical alternative in treatment of primary acquired nasolacrimal duct obstruction.
比较经泪小管二极管激光泪囊鼻腔吻合术（TCDL-DCR）和外路泪囊鼻腔吻合术（EX-DCR）治疗原发性获得性鼻泪管阻塞患者的手术成功率、并发症发生率及患者不适率。
本研究纳入80例连续患者，根据泪囊鼻腔吻合术技术分组。34例（42.5%）患者接受TCDL-DCR（A组），46例（57.5%）患者（B组）接受带临时硅胶支架植入的EX-DCR。手术成功的判定依据为溢泪症状缓解、患者满意度、泪囊开口通畅的内镜评估以及泪道冲洗。采用Pearson卡方检验、Fisher精确检验和Student t检验进行统计学分析。
A组包括22例女性和12例男性，平均年龄49.1±15.1岁；B组包括35例女性和11例男性，平均年龄50.8±11.7岁。两组在年龄和性别方面无差异（分别为P = 0.905和P = 0.167）。A组手术时长为22.2±4.8分钟，而B组为56.3±15.7分钟（P = 0.0001）。A组有2例患者记录到中鼻甲损伤，B组有14例患者经历了轻度至重度围手术期出血。两组围手术期并发症发生率有显著差异（P = 0.004）。A组症状缓解成功率为79.4%，B组为89.1%。成功率差异无统计学意义（P = 0.229）。
虽然EX-DCR的成功率高于TCDL-DCR，但TCDL-DCR手术时间短、围手术期并发症发生率低且成功率相近，可能是治疗原发性获得性鼻泪管阻塞的一种良好且可接受的手术选择。
