Gani Kaamil, Castelhano Luís, Correia Filipe, Reis Luís Roque, Escada Pedro
Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1613-1618. doi: 10.1007/s12070-023-04368-y. Epub 2023 Nov 28.
Dacryocystorhinostomy is the gold-standard for distal lacrimal obstructions. This study aims to report the demography, clinical presentation, influence of agger nasi opening, uncinectomy and septoplasty, the use of silicone stent tubes, complications and success of endoscopic and external dacryocystorhinostomy over a period of 11 years. Retrospective review of clinical records, from January 2012 to December 2022, at a tertiary center in Portugal. A total of 249 procedures, 6 external and 243 endoscopic, were performed, including 39 revision cases. There was a female predominance (79.9%) with a mean age at diagnosis of 66.4 years. Recurrent acute dacryocystitis, reported by 33.3%, was associated with higher success ( = 0.053). Agger nasi opening, uncinectomy and septoplasty were performed in 17.7%, 6.0% and 15.3% respectively, although associated with higher success rates, no statistically significant difference was found. Minor complication rates for both external and endoscopic approach was 33.3% and 32.1% respectively. Functional and anatomical success was 100% and 83.3%, respectively, for external dacryocystorhinostomy, and 91.4% and 85.1%, respectively, for endoscopic dacryocystorhinostomy. Revision surgery was associated with a worse anatomical success ( = 0.05). Endoscopic dacryocystorhinostomy is an effective and safe alternative to the external approach. Minor procedures can increase the success rate, but multicentre studies need to be performed for a statistically significant result.
泪囊鼻腔吻合术是治疗泪道远端阻塞的金标准。本研究旨在报告11年间内镜和外路泪囊鼻腔吻合术的人口统计学、临床表现、鼻丘气房开放、钩突切除术和鼻中隔成形术的影响、硅胶支架管的使用、并发症及成功率。对葡萄牙一家三级中心2012年1月至2022年12月的临床记录进行回顾性分析。共进行了249例手术，其中6例为外路手术，243例为内镜手术，包括39例翻修病例。女性占主导地位（79.9%），诊断时的平均年龄为66.4岁。33.3%的患者报告有复发性急性泪囊炎，其成功率较高（P = 0.053）。分别有17.7%、6.0%和15.3%的患者进行了鼻丘气房开放、钩突切除术和鼻中隔成形术，尽管成功率较高，但未发现统计学上的显著差异。外路和内镜手术的轻微并发症发生率分别为33.3%和32.1%。外路泪囊鼻腔吻合术的功能成功率和解剖成功率分别为100%和83.3%，内镜泪囊鼻腔吻合术分别为91.4%和85.1%。翻修手术的解剖成功率较低（P = 0.05）。内镜泪囊鼻腔吻合术是外路手术的一种有效且安全的替代方法。小型手术可提高成功率，但需要进行多中心研究以获得具有统计学意义的结果。
