儿童鼻泪管阻塞的原发性非内镜鼻内与外路泪囊鼻腔造口术对比
Primary nonendoscopic endonasal versus external dacryocystorhinostomy in nasolacrimal duct obstruction in children.
作者信息
Bothra Nandini, Wani Raashid M, Ganguly Anasua, Tripathy Devjyoti, Rath Suryasnata
机构信息
Department of Ophthalmic Plastic and Reconstructive Surgery Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
出版信息
Indian J Ophthalmol. 2017 Oct;65(10):1004-1007. doi: 10.4103/ijo.IJO_188_17.
PURPOSE
The aim is to compare the outcome of nonendoscopic endonasal dacryocystorhinostomy (NEN DCR) with external DCR (EXT-DCR) in the treatment of nasolacrimal duct obstruction (NLDO) in children.
METHODS
A retrospective, comparative chart analysis of all consecutive children <16 years after EXT-DCR or NEN-DCR between June 2012 and February 2016.
RESULTS
Seventy-one children (79 eyes) underwent DCR in the study, of which 37 children (40 eyes) underwent EXT-DCR and 34 (39 eyes) NEN-DCR. Mean age of both groups (8.7 vs. 7.7 years) was comparable. Etiologically, persistent congenital NLDO was the most common indication (50% vs. 72%), followed by acquired and secondary NLDO. Mean duration was shorter for NEN-DCR (47 vs. 37 min; P = 0.0021). Mitomycin C 0.04% was used more often in NEN-DCR (10% vs. 56.41%). Success after primary EXT-DCR was 100% as compared to 75% for primary NEN-DCR at median follow-up of 12 and 16 months respectively. At revision, the main cause of failure was granuloma (60%). After revision, all eyes were symptom-free at a median follow-up of 9.5 months.
CONCLUSION
Primary NEN-DCR has a poorer outcome than EXT-DCR in the treatment of NLDO in children and is more likely to need a revision procedure.
目的
比较非内镜下经鼻泪囊鼻腔造口术（NEN DCR）与外路泪囊鼻腔造口术（EXT-DCR）治疗儿童鼻泪管阻塞（NLDO）的效果。
方法
对2012年6月至2016年2月期间接受EXT-DCR或NEN-DCR治疗的所有16岁以下连续儿童进行回顾性比较图表分析。
结果
71名儿童（79只眼）在本研究中接受了泪囊鼻腔造口术，其中37名儿童（40只眼）接受了EXT-DCR，34名（39只眼）接受了NEN-DCR。两组的平均年龄（8.7岁对7.7岁）具有可比性。病因方面，持续性先天性鼻泪管阻塞是最常见的适应证（50%对72%），其次是后天性和继发性鼻泪管阻塞。NEN-DCR的平均手术时间较短（47分钟对37分钟；P = 0.0021）。0.04%的丝裂霉素C在NEN-DCR中使用更为频繁（10%对56.41%）。初次EXT-DCR后的成功率为100%，而初次NEN-DCR的成功率在分别为12个月和16个月的中位随访时为75%。在翻修时，失败的主要原因是肉芽肿（60%）。翻修后，所有眼睛在9.5个月的中位随访时均无症状。
结论
在治疗儿童鼻泪管阻塞方面，初次NEN-DCR的效果比EXT-DCR差，并且更有可能需要进行翻修手术。
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