Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China.
Department of Ophthalmology, Peking University People's Hospital, Beijing, 100044, China.
Eur Arch Otorhinolaryngol. 2022 Oct;279(10):5025-5032. doi: 10.1007/s00405-022-07347-1. Epub 2022 Mar 23.
Although endoscopic dacryocystorhinostomy (DCR) is a standard procedure for nasolacrimal duct obstruction (NLDO), the failure rate remains approximately 10%. A small lacrimal sac is considered the main reason for surgical failure. We explored the efficacy of endoscopic DCR for the treatment of NLDO with a small lacrimal sac.
The clinical data of 72 patients (88 eyes) diagnosed with NLDO and undergoing endoscopic DCR from 2012 to 2020, with at least 24 months of follow-up were retrospectively collected. Intraoperatively, the Rosenmüller valves were fully exposed, mucosal flaps were preserved to cover the naked bone, and a silicone tube was implanted if necessary. Postoperative intervention was performed if necessary. The main outcome measures were symptomatic improvement and objective ostium patency.
Eighty-eight eyes of 72 patients were divided into two groups: the refractory group (34 patients, 47 eyes), with a small lacrimal sac (≤ 5 mm in diameter), and the simple group (38 patients, 41 eyes). Patients with small lacrimal sacs were more prone to bilateral eye disease than those in the simple group (P = 0.014) and required a longer postoperative follow-up (P < 0.001). Refractory NLDO and simple NLDO had a success rate of 91.5% and 95.1%, respectively, with no significant difference.
Endoscopic DCR for refractory NLDO with a small lacrimal sac could achieve a beneficial result by exposing the Rosenmüller valves, preserving mucosal flaps, implanting necessary intubation, and intervening postoperatively. Thus, a small lacrimal sac should not be regarded as a contraindication to surgery.
尽管内镜下鼻内泪囊吻合术（DCR）是治疗鼻泪管阻塞（NLDO）的标准方法，但失败率仍约为 10%。小泪囊被认为是手术失败的主要原因。我们探讨了内镜下 DCR 治疗小泪囊 NLDO 的疗效。
回顾性收集 2012 年至 2020 年间诊断为 NLDO 并接受内镜 DCR 治疗的 72 例患者（88 只眼）的临床资料，随访时间至少 24 个月。术中充分暴露罗森穆勒瓣，保留黏膜瓣覆盖裸露骨质，必要时植入硅胶管。术后必要时进行干预。主要观察指标为症状改善和客观吻合口通畅情况。
72 例患者 88 只眼分为两组：难治性组（34 例，47 只眼），泪囊较小（直径≤5mm），单纯组（38 例，41 只眼）。小泪囊患者比单纯组更倾向于双侧发病（P=0.014），且术后随访时间更长（P<0.001）。难治性 NLDO 和单纯 NLDO 的成功率分别为 91.5%和 95.1%，差异无统计学意义。
通过暴露罗森穆勒瓣、保留黏膜瓣、植入必要的插管和术后干预，内镜下 DCR 治疗小泪囊难治性 NLDO 可以取得良好的效果。因此，小泪囊不应被视为手术的禁忌证。
