State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, 510060, China.
Ophthalmologic Center, First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, 844000, China.
Int Ophthalmol. 2023 Jan;43(1):63-71. doi: 10.1007/s10792-022-02388-1. Epub 2022 Jul 15.
This study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C.
A prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA).
A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period.
Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.
本研究评估了内镜缝合和吻合术（eSK-DCR）在不使用支架或丝裂霉素 C 的情况下的长期效果。
对 2019 年 10 月至 2019 年 12 月在中山大学眼科中心接受内镜 DCR 的鼻泪管阻塞（NLDO）患者进行前瞻性干预性病例系列研究。外科医生在内镜 DCR 下通过打结将泪囊黏膜与鼻腔黏膜缝合。收集患者的人口统计学、术前和术后数据，包括临床表现、溢泪的 Munk 评分、手术指征、手术时间、打结时间、打结次数、内镜造口大小、并发症以及解剖和功能成功。解剖成功定义为泪道冲洗时造口通畅，功能成功定义为症状主观改善。使用 IBM SPSS 软件（版本 20.0；SPSS Inc.，芝加哥，IL，USA）进行统计分析。
共有 60 例（71 只眼）患者行单纯 eSK-DCR。其中，95.0%（57/60）为女性。患者的平均年龄为 54.7 岁。平均手术时间为 37.60 分钟，平均每个结的时间为 2.86 分钟。内镜证据显示，所有患者在 4 周后均显示出通畅的造口和正常的瓣愈合。与术前评分相比，术后 6 个月 Munk 评分显著下降（P<0.0001）。尽管在 2 年随访结束时有 4 例（7 只眼）患者失访，但在 2 年随访期间，解剖和功能成功率保持稳定（解剖成功率 100%；功能成功率 87.5%）。在随访期间未发现严重并发症。
单纯 eSK-DCR 是治疗 NLDO 的一种简单可靠的治疗方法。手术效果良好，术后 6 个月仍保持稳定。
