Daraei Pedram, DelGaudio John M
Sinus, Nasal, and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.
JAMA Otolaryngol Head Neck Surg. 2014 Aug;140(8):736-41. doi: 10.1001/jamaoto.2014.1038.
Epiphora is a symptom resulting from obstruction of the nasolacrimal system. Classically, dacryocystorhinostomy has been performed to relieve epiphora. However, this does not address distal obstruction. Inferior meatus (IM) surgery at or near Hasner's valve has been shown to have a 92.8% short-term success rate in treating distal nasolacrimal duct (NLD) obstruction. In addition, IM surgery for proximal obstruction has shown poor success rates. Differentiation between distal and proximal obstruction would allow for more appropriate treatment and improved patient outcomes. To date, no study has addressed long-term outcomes or the workup for distal and proximal NLD obstructions.
To report long-term outcomes in a subset of patients with epiphora due to distal NLD obstruction who underwent IM surgery and to present a treatment paradigm to differentiate distal from proximal NLD obstruction.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective medical record review with follow-up telephone survey was conducted at a tertiary referral center. Participants were patients surgically treated for epiphora from July 2006 to March 2010.
Inferior meatus surgery was performed to relieve epiphora in patients with distal NLD obstruction.
Improvement or resolution of epiphora.
Seventeen patients were contacted for follow-up; 13 patients responded, representing 18 nasolacrimal systems. One patient (2 sides) was excluded owing to the surgical specimen showing leukemic infiltrates. Mean time of follow-up was 6.2 years. Ten sides had distal NLD obstruction. Of the nasolacrimal systems with distal obstruction, 9 had long-term subjective improvement of symptoms (90%). No patient had nasal complications.
Directed IM endoscopic surgery resulted in long-term improvement of epiphora in 90% of nasolacrimal systems when performed for distal NLD obstruction. A treatment paradigm was developed and is detailed herein.
溢泪是鼻泪系统阻塞导致的一种症状。传统上，一直通过泪囊鼻腔吻合术来缓解溢泪。然而，这并不能解决远端阻塞问题。已证明在哈氏瓣膜处或其附近进行下鼻道（IM）手术治疗远端鼻泪管（NLD）阻塞的短期成功率为92.8%。此外，IM手术治疗近端阻塞的成功率较低。区分远端和近端阻塞将有助于采取更合适的治疗方法并改善患者预后。迄今为止，尚无研究涉及远端和近端NLD阻塞的长期预后或检查方法。
报告因远端NLD阻塞而接受IM手术的溢泪患者亚组的长期预后情况，并提出一种区分远端与近端NLD阻塞的治疗模式。
设计、地点和参与者：本研究在一家三级转诊中心进行，采用回顾性病历审查及随访电话调查。参与者为2006年7月至2010年3月期间因溢泪接受手术治疗的患者。
对远端NLD阻塞的患者进行下鼻道手术以缓解溢泪。
溢泪症状改善或消失。
联系了17例患者进行随访；13例患者回复，代表18个鼻泪系统。1例患者（双侧）因手术标本显示白血病浸润而被排除。平均随访时间为6.2年。10侧存在远端NLD阻塞。在有远端阻塞的鼻泪系统中，9侧症状得到长期主观改善（90%）。无患者出现鼻部并发症。
针对远端NLD阻塞进行IM内镜手术时，90%的鼻泪系统溢泪症状得到长期改善。本文制定并详细阐述了一种治疗模式。
