Hartikainen J, Grenman R, Puukka P, Seppä H
Department of Ophthalmology, University of Turku, Finland.
Ophthalmology. 1998 Jun;105(6):1106-13. doi: 10.1016/S0161-6420(98)96015-8.
The introduction of endonasal laser dacryocystorhinostomy (ENL-DCR) in the early 1990s showed great promise of changing dacryocystorhinostomy into an elegant, minimally invasive procedure from the traditional external dacryocystorhinostomy (EXT-DCR). This prospective, randomized study compares these two operations, their success rates, surgical durations, and postoperative symptoms.
A total of 64 cases in 61 patients with primary acquired nasolacrimal sac or duct obstruction were divided into 2 subgroups by symptoms (simple epiphora and chronic dacryocystitis). These patients were randomized within both subgroups into 2 operation groups with 32 cases in each group.
Altogether, 32 EXT-DCRs and 32 ENL-DCRs were performed. The silicone tube was removed at 6 months after surgery. The final follow-up visit was at 1 year after surgery. The patency of the lacrimal passage was investigated by irrigation, and patients were questioned about their symptoms.
The patency of the lacrimal passage to irrigation and the duration of surgery were measured.
The success rate at 1 year after surgery was 91% for EXT-DCR and 63% for ENL-DCR after primary surgery. The difference was statistically significant (P = 0.016). The surgical duration for ENL-DCR was three times shorter than for EXT-DCR, the average duration being 23 minutes and 78 minutes, respectively (P < 0.0001).
The EXT-DCR, when compared with ENL-DCR, seems to provide superior operation results in primary acquired nasolacrimal duct obstruction.
20世纪90年代初鼻内镜下激光泪囊鼻腔造口术（ENL-DCR）的引入，显示出将泪囊鼻腔造口术从传统的外路泪囊鼻腔造口术（EXT-DCR）转变为一种精巧的微创手术的巨大前景。这项前瞻性随机研究比较了这两种手术、它们的成功率、手术时间和术后症状。
61例原发性获得性鼻泪囊或鼻泪管阻塞患者共64例，按症状（单纯溢泪和慢性泪囊炎）分为2个亚组。这些患者在两个亚组内随机分为2个手术组，每组32例。
共进行了32例EXT-DCR和32例ENL-DCR。术后6个月取出硅胶管。最后一次随访在术后1年。通过冲洗检查泪道通畅情况，并询问患者症状。
测量泪道冲洗通畅情况和手术时间。
初次手术后，EXT-DCR术后1年成功率为91%，ENL-DCR为63%。差异有统计学意义（P = 0.016）。ENL-DCR的手术时间比EXT-DCR短三倍，平均手术时间分别为23分钟和78分钟（P < 0.0001）。
与ENL-DCR相比，EXT-DCR在原发性获得性鼻泪管阻塞中似乎能提供更好的手术效果。
