Davies Brett W, McCracken Michael S, Hawes Michael J, Hink Eric M, Durairaj Vikram D, Pelton Ron W
*Oculofacial Plastic and Orbital Surgery, University of Colorado Hospital, Aurora, Colorado; †McCracken Eye and Face Institute, Parker, Colorado; ‡Denver, Colorado; §Texas Oculoplastic Consultants, Austin, Texas; and ‖Colorado Springs, Colorado, U.S.A.
Ophthalmic Plast Reconstr Surg. 2015 Jul-Aug;31(4):278-81. doi: 10.1097/IOP.0000000000000302.
Scar formation is a frequently cited complication of external dacryocystorhinostomy (exDCR). The purpose of this study is to evaluate scar appearance after exDCR with the skin incision placed in the tear trough.
Multicenter, prospective, noncomparative interventional study was approved by the University of Colorado Institutional Review Board. Patients undergoing exDCR from February 2013 to January 2014 were included in the study, and surgeries were performed by all authors. The incision site for all patients started just under the medial canthal tendon and extended inferolaterally into the tear trough for 10 mm to 15 mm. External dacryocystorhinostomy was performed in the usual manner, and the incision was closed according to the surgeon's preference. At 3 months postop, all patients were asked to rate their scar on the basis of the following grading scale: 0, invisible incision; 1, minimally visible incision; 2, moderately visible incision; and 3, very visible incision. Functional success of the surgery was also determined by asking the patients if their symptoms resolved, improved, or did not change. External photographs taken at 3 months after surgery were graded by 3 independent oculofacial and facial plastic surgeons using the same grading scale.
Seventy-two surgeries were performed in 68 consecutive exDCR patients with nasolacrimal duct obstruction during the study period. Sixty-nine out of 72 patients reported improved or resolved symptoms (95.8%). The average patient scar grade was 0.21, while the average surgeon scar grade was 0.99 (p < 0.001). Sixty out of the 72 patients graded the scar as invisible (83.3%), and only 3 patients graded the scar as moderately visible (4.2%). No patients graded the scar as very visible. Of the 216 surgeon grades, 55 scars were graded as invisible (25.5%), while 8 were graded as very visible (3.7%).
Scar appearance after exDCR with the incision placed in the tear trough is minimally visible to surgeons, and more importantly, nearly invisible to patients.
瘢痕形成是经外部泪囊鼻腔造口术（exDCR）后经常被提及的并发症。本研究的目的是评估将皮肤切口置于泪沟处的exDCR术后的瘢痕外观。
多中心、前瞻性、非对照干预性研究获科罗拉多大学机构审查委员会批准。纳入2013年2月至2014年1月期间接受exDCR的患者，所有作者均参与手术。所有患者的切口部位始于内眦腱下方，向下外侧延伸至泪沟10毫米至15毫米。以常规方式进行外部泪囊鼻腔造口术，并根据外科医生的偏好关闭切口。术后3个月，要求所有患者根据以下分级量表对其瘢痕进行评分：0级，切口不可见；1级，切口轻微可见；2级，切口中度可见；3级，切口非常可见。通过询问患者症状是否缓解、改善或未改变来确定手术的功能成功率。术后3个月拍摄的外部照片由3名独立的眼面部和面部整形外科医生使用相同的分级量表进行评分。
在研究期间，对68例连续的鼻泪管阻塞患者进行了72例手术。72例患者中有69例报告症状改善或缓解（95.8%）。患者瘢痕平均评分为0.21，而外科医生瘢痕平均评分为0.99（p<0.001）。72例患者中有60例将瘢痕评为不可见（83.3%），只有3例患者将瘢痕评为中度可见（4.2%）。没有患者将瘢痕评为非常可见。在216次外科医生评分中，55处瘢痕被评为不可见（25.5%），而8处被评为非常可见（3.7%）。
将切口置于泪沟处的exDCR术后瘢痕外观对外科医生来说几乎不可见，更重要的是，对患者来说几乎不可见。
