Jayantha Kedilaya Yashveer, Chacko Aneena, Poorey V K
Department of ENT, Gandhi Medical College, Bhopal, MP 462001 India.
Indian J Otolaryngol Head Neck Surg. 2018 Dec;70(4):477-481. doi: 10.1007/s12070-018-1498-x. Epub 2018 Sep 19.
Many surgical advancement paved to surgical success in endonasal endoscopic dacryocystorhinostomy. Mitomycin C is a systemic chemotherapeutic agent derived from that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. The objective of the study was to evaluate the advantage of mitomycin C in primary endoscopic endonasal dacryocystorhinostomy without stenting. Randomised case control design. Tertiary academic centre in central India. 112 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups with or without mitomycin C intraoperative application. 112 eyes underwent endoscopic-dacryocystorhinostomy. Additional surgeries were done according to necessity. Mitomycin C was applied in concentration of 0.4 mg/dl for 5 min. Patients were followed up on OPD-basis at the end of 1st week, 1st month, 3rd month and over phone call at end of 1 year. Symptomatic improvement assessed by verbal enquiry and clinically by syringing by ophthalmologist. 8 patients underwent septal surgery in case group and 4 in control group along with 1 concha bullosa correction in the case group ( < 0.05). Nil intraoperative complications ( < 0.05) and nil postoperative complication noted ( < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96.5% at 3rd month in case group and 96.4% and 92.9% at 1 month and 3 month respectively in control group. Nasal endoscopy of all surgical failures showed restenosis in both case group and control group except 1 patient with granulation in control group. Eventhough intraoperative mitomycin C application is effective in increasing the success rate of endonasal DCR surgery in standard nasolacrimal duct obstruction, and with no significant complications from its use, the study did not show added benefit in the primary endoscopic endoscopic dacryocystorhinostomy without stenting.
许多手术进展为鼻内镜下泪囊鼻腔造口术的手术成功铺平了道路。丝裂霉素C是一种从链霉菌属中提取的全身化疗药物，它通过抑制成纤维细胞胶原蛋白的合成来抑制DNA、细胞RNA和蛋白质的合成。本研究的目的是评估丝裂霉素C在无支架置入的原发性鼻内镜下泪囊鼻腔造口术中的优势。随机病例对照设计。印度中部的三级学术中心。选取112例因溢泪就诊且经眼科医生冲洗后诊断为慢性泪囊炎的患者，随机分为两组，一组术中应用丝裂霉素C，另一组不应用。112只眼接受了内镜下泪囊鼻腔造口术。根据需要进行了额外的手术。丝裂霉素C以0.4mg/dl的浓度应用5分钟。在第1周、第1个月、第3个月结束时在门诊进行随访，并在1年结束时通过电话随访。通过口头询问评估症状改善情况，并由眼科医生通过冲洗进行临床评估。病例组有8例患者接受了鼻中隔手术，对照组有4例，病例组还有1例进行了泡状鼻甲矫正（P<0.05）。术中无并发症（P<0.05），术后也无并发症（P<0.05）。两组在第1周结束时功能和解剖通畅率均为100%，病例组在第3个月时为96.5%，对照组在第1个月和第3个月时分别为96.4%和92.9%。所有手术失败患者的鼻内镜检查显示，病例组和对照组均有再狭窄，对照组有1例患者出现肉芽组织。尽管术中应用丝裂霉素C可有效提高标准鼻泪管阻塞患者鼻内镜下泪囊鼻腔造口术的成功率，且使用该药物无明显并发症，但本研究未显示在无支架置入的原发性鼻内镜下泪囊鼻腔造口术中应用丝裂霉素C有额外益处。
