Eloy P, Bertrand B, Martinez M, Hoebeke M, Watelet J B, Jamart J
Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital, UCL de Mont-Godinne, Yvoir, Belgium.
Rhinology. 1995 Dec;33(4):229-33.
Dacryocystorhinostomy (DCR) allows an obstructed lachrymal drainage system to be drained into the nasal fossa. Since the development of endonasal microsurgical techniques, the endonasal approach presents itself as an alternative choice to the conventional external approach. It is far less traumatic, yet as efficacious as the conventional approach, and avoids the need for a skin incision and the disruption of the medial canthal structures. Twenty-six patients suffering from lachrymal system obstruction underwent 28 endonasal dacryocystorhinostomies under microscopical (n = 25) or endoscopic control (n = 3). Pre-operative assessment included clinical symptoms (sac swelling, purulent secretions, epiphora) and outflow obstruction on X-rays (conventional dacryocystography and/or subtraction macrodacryocystography). Post-operatively, 23 DCR were free of symptoms. Two presented occasional epiphora and three were unsuccessful. The presence of pre-operative purulent secretions was significantly correlated with post-operative success and with lachrymal sac patency, which is also confirmed by X-ray examination (p<0.001). Thus in cases of purulent secretion with epiphora, X-ray examination is redundant and may be avoided. On the contrary, when epiphora is an isolated symptom, X-rays must be performed in order to determine where the obstruction is located and to provide information on lachrymal sac morphology.
泪囊鼻腔造口术（DCR）可使阻塞的泪液引流系统引流至鼻窝。自鼻内显微外科技术发展以来，鼻内入路成为传统外部入路的一种替代选择。它的创伤小得多，但与传统方法一样有效，且避免了皮肤切口以及内眦结构的破坏。26例泪液系统阻塞患者在显微镜（n = 25）或内镜（n = 3）控制下接受了28次鼻内泪囊鼻腔造口术。术前评估包括临床症状（泪囊肿胀、脓性分泌物、溢泪）以及X线检查显示的流出道阻塞（传统泪囊造影和/或减影泪囊造影）。术后，23例泪囊鼻腔造口术无症状。2例偶尔出现溢泪，3例手术失败。术前脓性分泌物的存在与术后成功及泪囊通畅显著相关，X线检查也证实了这一点（p<0.001）。因此，在伴有溢泪的脓性分泌物病例中，X线检查是多余的，可以避免。相反，当溢泪是孤立症状时，必须进行X线检查以确定阻塞部位并提供泪囊形态的信息。
