Ali Mohammad Javed, Ganguly Anasua, Ali Mohammad Hasnat, Naik Milind N
Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India.
Center for Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Hyderabad, India.
Int Forum Allergy Rhinol. 2015 Aug;5(8):764-7. doi: 10.1002/alr.21522. Epub 2015 Mar 24.
The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr.
This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, soft tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests.
A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanical burr group was 3.71 minutes (range, 1.75 to 6.58 minutes); in the ultrasonic group it was 4.12 minutes (range, 1.33 to 6.25 minutes). There was no significant difference (p = 0.17) between the 2 groups. Subcategory analyses of time taken by age (p = 0.057) and sex (p = 0.56) did not show any difference between the groups. Two patients in the mechanical burr group had an insignificant superficial sac injury and 1 patient in the ultrasonic group suffered epithelial burns away from the site of osteotomy, which resolved spontaneously without any sequelae. There was no excess bleeding in any of the groups.
The time taken by mechanical burr and piezoelectric system are comparable for superior osteotomy in PEnDCR. If anatomical boundaries are respected, their use appears to be safe without major complications.
本研究旨在报告在使用压电系统和机械磨头进行原发性动力性鼻泪管吻合术（PEnDCR）的上颌骨截骨步骤中所花费的时间及该步骤中的并发症情况。
对在4个月期间连续接受原发性PEnDCR手术的所有患者进行了这项前瞻性干预性比较研究。手术按照标准方案进行，所有患者均由同一外科医生（M.J.A.）实施手术。记录的参数包括人口统计学数据、使用的动力器械类型、上颌骨截骨所花费的时间、鼻丘暴露情况、整个泪囊暴露情况以及诸如出血过多、软组织损伤或黏膜烧伤等并发症。使用线性混合效应模型和双样本t检验进行统计分析。
共研究了55例PEnDCR手术，其中机械磨头组29例，压电或超声组26例。机械磨头组上颌骨截骨的平均时间为3.71分钟（范围为1.75至6.58分钟）；超声组为4.12分钟（范围为1.33至6.25分钟）。两组之间无显著差异（p = 0.17）。按年龄（p = 0.057）和性别（p = 0.56）进行的亚组分析显示两组之间无任何差异。机械磨头组有2例患者出现轻微的泪囊浅表损伤，超声组有1例患者在截骨部位以外出现上皮烧伤，可自行缓解且无任何后遗症。所有组均未出现出血过多的情况。
在PEnDCR的上颌骨截骨术中，机械磨头和压电系统所花费的时间相当。如果尊重解剖边界，使用它们似乎是安全的，不会出现重大并发症。
