CAJ | 학술논문

目的探讨内镜下经鼻径路泪囊鼻腔造瘘术(EE-DCR)联合新型泪囊造瘘口扩张支架(LOES)植入术治疗鼻泪管支架(NDS)嵌顿的慢性泪囊炎患者的可行性.方法回顾性系列病例研究.2009年10月至2011年12月期间对并发NDS嵌顿的慢性泪囊炎患者65例施行EE-DCR取出支架,同时植入自主研发的新型LOES以扩张泪囊造瘘口.LOES留置3～6个月后取出,继续随访观察6个月后评价泪液引流重建成功率.结果祛除随访资料不完整者10例,LOES过早脱落者4例,最终51例(51眼)纳入研究.术后LOES平均留置(4.1±0.5)个月,拔管后平均随访(9.7±3.2)个月.按照NDS头端形状分类,术中共取出菱形(21例)、倒钩形(12例)、侧三角形伞形(10例)、喇叭口状(4例)、梭形(2例)与球囊状(2例)等6种形状的NDS.术中发现所有患者在植入的NDS头端与泪囊内壁之间、以及NDS管腔内均存大量瘢痕增生及肉芽组织形成,泪囊容积显著缩小.所有患者LOES拔除后泪囊造瘘口均开放,拔除后6个月复查,泪囊造瘘口开放率达94％(48/51),3例瘢痕闭锁.未见其他并发症发生.结论 EE-DCR联合新型LOES植入为一种重建NDS嵌顿的慢性泪囊炎患者泪液引流的有效方法,具有NDS取出便利、一期泪液引流重建成功率高、微创、无颜面部皮肤瘢痕、并发症少、安全可靠等优点.
목적 탐토내경하경비경로루낭비강조루술(EE-DCR)연합신형루낭조루구확장지가(LOES)식입술치료비루관지가(NDS)감돈적만성루낭염환자적가행성.방법 회고성계렬병례연구.2009년10월지2011년12월기간대병발NDS감돈적만성루낭염환자65례시행EE-DCR취출지가,동시식입자주연발적신형LOES이확장루낭조루구.LOES류치3～6개월후취출,계속수방관찰6개월후평개루액인류중건성공솔.결과 거제수방자료불완정자10례,LOES과조탈락자4례,최종51례(51안)납입연구.술후LOES평균류치(4.1±0.5)개월,발관후평균수방(9.7±3.2)개월.안조NDS두단형상분류,술중공취출릉형(21례)、도구형(12례)、측삼각형산형(10례)、나팔구상(4례)、사형(2례)여구낭상(2례)등6충형상적NDS.술중발현소유환자재식입적NDS두단여루낭내벽지간、이급NDS관강내균존대량반흔증생급육아조직형성,루낭용적현저축소.소유환자LOES발제후루낭조루구균개방,발제후6개월복사,루낭조루구개방솔체94％(48/51),3례반흔폐쇄.미견기타병발증발생.결론 EE-DCR연합신형LOES식입위일충중건NDS감돈적만성루낭염환자루액인류적유효방법,구유NDS취출편리、일기루액인류중건성공솔고、미창、무안면부피부반흔、병발증소、안전가고등우점.
Objective To develop a new method for the treatment of nasolacrimal duct stent (NDS) incarceration in patients with chronic dacryocystitis.Methods It was a retrospective case series study.Sixty-five patients (65 eyes) with nasolacrimal duct stent (NDS) incarceration from October 2009 to October 2011 were treated by endonasal endoscopic dacryocystorhinostomy (EE-DCR) to remove the incarcerated NDS,and meanwhile,a new lacrimal ostial expanding stent (LOES) was implanted to expand the lacrimal sac ostium.Following a 6-month follow-up after removing the LOES,the success rate of the tear drainage reconstruction was evaluated.Results Totally,51 cases with complete data were included in this study.Through the surgery,6 types of NDS with different head shapes,including diamond (21 cases),barb (12 cases),inverted triangle (10 cases),bell (4 cases),shuttle (2 cases),and ball (2 cases),were removed.In all patients,a large amount of scar and granulation tissue was found between the NDS head and the lacrimal sac wall,and within the NDS lumen,and thus the volume of the lacrimal sac was significantly reduced.In all patients,the lacrimal sac ostium was open following LOES removal.Even after 6 months,the rate of ostial opening was still 94％(48/51),and the other three patients showed scar atresia.No other complication was observed.Conclusion The combined therapy of EE-DCR and LOES implantation is an effective approach to reconstruct NDS incarceration in patients with chronic dacryocystitis,with extraordinary advantages including easy NDS removal,high success rate of Phase I tear drainage reconstruetion,minimally invasive and avoidance of facial skin scarring.