CAJ | 학술논문

目的探索MeroGel生物胶黏膜贴敷法作为鼻内窥镜下泪囊鼻腔黏膜吻合术(EES-DCR)术中黏膜瓣吻合的可行性,以期为EES-DCR提供一种新的黏膜瓣吻合方式.方法选取单纯性慢性泪囊炎270例(270只眼),随机分为MemGel组(A组)、银夹夹持组(B组)、空白对照组(C组)3组.所有患者接受常规EES-DCR,术中对泪囊后瓣与鼻黏膜瓣分别采用MeroGel贴敷、银夹夹持,单纯泪囊黏膜瓣贴敷作为空白对照组.术后定期随访,鼻内窥镜下观察造瘘口及其周围创面愈合与开放情况.根据造瘘口黏膜上皮化、开放与否、以及慢性泪囊炎治愈率做为指标进行疗效对比.结果术后随访6～12个月(平均8.6±2.2)月,资料齐全且符合本研究标准者共228例(228只眼),其中A组78例,B组69例,C组81例.A、B、C三组治愈率分别为94.9%(74/78)、75.4%(52/69)与76.5%(62/81),两两比较,A组与B、C两组之间差异统计学意义(P＜0.01),B、C两组之间差异统计学无意义(P＞0.05).A组泪囊造瘘口及周围黏膜完全上皮化时间为术后(9.1±1.4)d,明显快于B、C两者.同时,A组泪囊造瘘口周围瘢痕增生与肉芽组织形成明显少于B、C两组(P＜0.05).结论 MemGel黏膜瓣贴敷法可显著促进泪囊鼻腔黏膜吻合口上皮化进程,抑制瘢痕增生及肉芽组织形成,提高EES-DCR疗效,是一种简单易行、疗效确切、安全高效的鼻内窥镜下泪囊鼻腔黏膜吻合新方法
목적 탐색MeroGel생물효점막첩부법작위비내규경하루낭비강점막문합술(EES-DCR)술중점막판문합적가행성,이기위EES-DCR제공일충신적점막판문합방식.방법 선취단순성만성루낭염270례(270지안),수궤분위MemGel조(A조)、은협협지조(B조)、공백대조조(C조)3조.소유환자접수상규EES-DCR,술중대루낭후판여비점막판분별채용MeroGel첩부、은협협지,단순루낭점막판첩부작위공백대조조.술후정기수방,비내규경하관찰조루구급기주위창면유합여개방정황.근거조루구점막상피화、개방여부、이급만성루낭염치유솔주위지표진행료효대비.결과 술후수방6～12개월(평균8.6±2.2)월,자료제전차부합본연구표준자공228례(228지안),기중A조78례,B조69례,C조81례.A、B、C삼조치유솔분별위94.9%(74/78)、75.4%(52/69)여76.5%(62/81),량량비교,A조여B、C량조지간차이통계학의의(P＜0.01),B、C량조지간차이통계학무의의(P＞0.05).A조루낭조루구급주위점막완전상피화시간위술후(9.1±1.4)d,명현쾌우B、C량자.동시,A조루낭조루구주위반흔증생여육아조직형성명현소우B、C량조(P＜0.05).결론 MemGel점막판첩부법가현저촉진루낭비강점막문합구상피화진정,억제반흔증생급육아조직형성,제고EES-DCR료효,시일충간단역행、료효학절、안전고효적비내규경하루낭비강점막문합신방법
Objective To study the suitability of MeroGel sticking as a new way of a flap anastomosis in entranasal endoscopic dacryocystorhinostomy(EES-DCR)for chronic dacryocystitis.Methods Two hundred seventy patients with purely chronic dacryocystitis were randomly and equally divided into 3 groups:MeroGel stickinggroup(groupA),silver folder holding group(groupB)and negative control group(group C).All patients received conventional EES-DCR,during which the lacrimal sac and nasal mugosa was sticked and adhered and the wound surface around the lacrimal ostium was surrounded by the biological gel of Merogel in group A,and mucosa of the lacrimal sac and nose were held with a silver folder in group B,and the valve of the lacrimal sac was only adequately extended after removing the nasal mucosa valve in group C.The postoperative follow-up was periodically performed.When followed up,whether the ostium was patent and whether the wounded surface around the ostium was healed and covered by a perfect epithelial mucosa or not were observed under the endoscope.Success rate of ostium patency was recorded and used as standard for therapeutic outcome evaluation.Results All operations were completed uneventfully.The patients Were folowed up for 6 to 12 months(mean:8.6±2.2)months after operation.Two hundred twenty-eight patients(228 eyes) having completed throughout follow-up time and with total clinical data were included in this study,in which group A had 78 patients,group B had 69 patients,group C had 81 patients.The success rate of lacrimal system reconstruction was 94.9%(74/78)in group A,75.4%(52/69)in group B and 76.5%(62/81)in group C.There was significant statistical differencebetween groupA and B or between group A and C(P＜0.01),however,there was no meaningful statistical difference between group B and C(P＞0.05).The average time for mucosa epithelization of the wound surface around the lacrimal ostium was 9.1±1.4 days in group A,significantly shorter than that in group B and C(P＜0.01).And meanwhile,there were less scars and granulation formation around the lacrimal ostium in group A than group B or C(P＜0.05).Conclusionsmonths Mucosa sticking by MeroGel is an efficient method for the flap anastomosis of the lacrimal and nasal mucosa during EES-DCR for treatment of chronic dacryocystitis mainly because of its significant facilitating mucosa epithelization of the lacrimal ostium and its surroundings,inhibiting scarring or granuloma formation,and increasing success rate of lacrimal system reconstruction.