Department of Ophthalmology, The First People's Hospital of Changzhou, Changzhou, Jiangsu.
Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou.
J Craniofac Surg. 2024;35(2):e150-e154. doi: 10.1097/SCS.0000000000009910. Epub 2023 Nov 23.
This study aimed to determine the silicone tube intubation requirement for endoscopic dacryocystorhinostomy (En-DCR) in patients with acute dacryocystitis (AD) with acquired skin fistulization.
Between September 2012 and October 2020, patients with AD and acquired skin fistulization undergoing En-DCR at the Eye Hospital of Wenzhou Medical University were randomized into treatment groups in which silicone tube intubation was carried out or not (groups A and B, respectively). All patients with skin fistulae present for 1+ months at En-DCR underwent fistulectomy. Operative success was assessed at 12 months post En-DCR in both treatment groups. Multiple logistic analyses were performed to assess for influencing factors on surgical success.
This study evaluated 94 patients for whom complete postoperative data were available, including 45 in group A and 44 in group B. Overall, 15 patients underwent fistulectomy and En-DCR simultaneously (8 from group A; 7 from group B ). At 12-month follow-up, anatomic and functional success rates were higher for patients in group A (93.3%, 86.7%) relative to those in group B (77.3%, 68.2%) ( P <0.05). Intranasal ostium obstruction caused lacrimal passage reconstruction failure in group A. In contrast, intranasal ostium and canalicular obstruction caused it in patients in group B. No significant variations in operation success rates across groups were seen when group B cases with canalicular obstruction were eliminated from the analyses ( P =0.070, >0.05). Multiple logistic regression analysis showed operative success was significantly influenced by fistulectomy (OR: 1.641, P <0.05) and intubation (OR: -1.559, P <0.05).
These findings imply that in patients with AD with skin fistulization undergoing En-DCR, intraoperative intubation is linked with a lower incidence of canalicular obstruction and positive outcomes. Accordingly, intraoperative intubation should be performed when operating on patients with AD with skin fistulization.
本研究旨在确定内镜下鼻内泪囊吻合术（En-DCR）治疗急性泪囊炎（AD）合并后天性皮肤瘘管时硅胶管插管的需求。
2012 年 9 月至 2020 年 10 月，温州医科大学附属眼视光医院收治的 AD 合并后天性皮肤瘘管患者行 En-DCR 术，随机分为插管组（A 组）和非插管组（B 组）。所有皮肤瘘管存在超过 1 个月的患者行瘘管切除术。两组均在 En-DCR 术后 12 个月评估手术成功率。采用多因素逻辑回归分析评估影响手术成功率的因素。
本研究共纳入 94 例患者，其中 A 组 45 例，B 组 44 例。两组中共有 15 例患者同时行瘘管切除术和 En-DCR（A 组 8 例，B 组 7 例）。术后 12 个月，A 组患者的解剖成功率（93.3%，86.7%）和功能成功率（93.3%，86.7%）均高于 B 组（77.3%，68.2%）（P<0.05）。A 组患者因鼻腔内口阻塞导致泪道重建失败，而 B 组患者因鼻腔内口和泪小管阻塞导致失败。当将 B 组中伴有泪小管阻塞的患者从分析中排除后，两组间的手术成功率无显著差异（P=0.070，>0.05）。多因素逻辑回归分析显示，手术成功率受瘘管切除术（OR：1.641，P<0.05）和插管（OR：-1.559，P<0.05）的显著影响。
这些结果表明，对于 AD 合并皮肤瘘管的患者行 En-DCR 术时，术中插管可降低泪小管阻塞的发生率，提高手术成功率。因此，对于 AD 合并皮肤瘘管的患者，术中应行插管。
