Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal.
Nepal J Ophthalmol. 2020 Jul;12(24):209-215. doi: 10.3126/nepjoph.v12i2.25655.
Dacryocystorhinostomy (DCR) is the commonest surgery for nasolacrimal duct obstruction. Inhibition of the scarring process within the anastomosis and rhinostomy site which has been attributed to the failure of this procedure, might improve the success rate of DCR. The objective of this study was to evaluate the outcomes of DCR with Mitomycin-C (MMC) and to compare the results of DCR with and without MMC.
A hospital based, prospective study was conducted in patients with primary acquired nasolacrimal duct obstruction. Standard conventional DCR was performed upto the level of creation of flaps. Application of MMC 0.2 mg/ml in and around the ostium and underneath the created flaps for two minutes was effected with cotton pledgets. The area was thoroughly washed with normal saline after removal of the pledgets. Rest of the surgery was completed as usual. The patients were followed up on the first postoperative day, one month and three months post surgery.
A total of 60 cases, 30 in each group were allocated. The success rate of DCR with MMC was found to be 96.7% compared to 86.7% (p=0.35) in the DCR group at the end of three months duration.
Intraoperative application of MMC during conventional DCR surgery provides a comparatively higher success rate than DCR without MMC without posing any extra financial burden and adverse drug reaction to the patient.
泪囊鼻腔吻合术（DCR）是治疗鼻泪管阻塞最常见的手术。吻合口和鼻造口部位的瘢痕形成过程受到抑制，这可能是该手术失败的原因，抑制这一过程可能会提高 DCR 的成功率。本研究的目的是评估丝裂霉素 C（MMC）在 DCR 中的应用效果，并比较有和没有 MMC 的 DCR 结果。
这是一项在原发性获得性鼻泪管阻塞患者中进行的基于医院的前瞻性研究。标准的常规 DCR 一直做到创建皮瓣的水平。用棉片将 MMC 0.2mg/ml 涂抹在泪囊造口和周围以及创建的皮瓣下方 2 分钟。去除棉片后，用生理盐水彻底冲洗该区域。其余手术照常进行。术后第 1 天、1 个月和 3 个月对患者进行随访。
共纳入 60 例患者，每组 30 例。在 3 个月时，MMC 组的 DCR 成功率为 96.7%，而 DCR 组为 86.7%（p=0.35）。
在常规 DCR 手术中，术中应用 MMC 比不使用 MMC 提供了更高的成功率，且不会给患者带来额外的经济负担和药物不良反应。
