CAJ | 학술논문

目的：外路泪囊鼻腔吻合术（DCR）失败原因及Nd：YAG激光再疏通效果的认知存在争议，本文旨在探讨其失败背后的深层原因，并评估经泪小管Nd：YAG激光再疏通的效果。方法20例外路DCR失败患者接受Nd：YAG激光泪道疏通，并通过回顾文献，与鼻窦内窥镜下修复及二次外路手术的效果进行了比较。结果20例（21眼，共23次）外路DCR失败患者接受经泪小管Nd：YAG激光疏通治疗，其中仅3例探及造瘘口。具体的失败原因包括造瘘口缺如、膜性鼻泪管阻塞、骨性鼻泪管狭窄、泪小管阻塞、造瘘口瘢痕形成、造瘘口位置不当、丝线残留。成功率52．38％。平均随访时间85．7个月（7个月至12．8年）。结论透过具体原因发现，作为目前国内治疗鼻泪管阻塞最常用的手术方法，由非泪道专业医师完成本身成为外路DCR失败的重要原因。建议手术分级及准入体系应严格执行。而经泪小管Nd：YAG激光再疏通虽然部分有效，但成功率远低于鼻窦内窥镜下修复及二次外路手术。
목적：외로루낭비강문합술（DCR）실패원인급Nd：YAG격광재소통효과적인지존재쟁의，본문지재탐토기실패배후적심층원인，병평고경루소관Nd：YAG격광재소통적효과。방법20예외로DCR실패환자접수Nd：YAG격광루도소통，병통과회고문헌，여비두내규경하수복급이차외로수술적효과진행료비교。결과20례（21안，공23차）외로DCR실패환자접수경루소관Nd：YAG격광소통치료，기중부3례탐급조루구。구체적실패원인포괄조루구결여、막성비루관조새、골성비루관협착、루소관조새、조루구반흔형성、조루구위치불당、사선잔류。성공솔52．38％。평균수방시간85．7개월（7개월지12．8년）。결론투과구체원인발현，작위목전국내치료비루관조새최상용적수술방법，유비루도전업의사완성본신성위외로DCR실패적중요원인。건의수술분급급준입체계응엄격집행。이경루소관Nd：YAG격광재소통수연부분유효，단성공솔원저우비두내규경하수복급이차외로수술。
Objective Owing to opinions varied on reasons of unsuccessful dacryocystorhinostomy (DCR) and efficacy of Nd:YAG laser revision,hence to investigate deep reason for primary external DCR failure and to evaluate the effectiveness of transcanalicular Nd:YAG laser on revision. Methods The 20 patients after failed external DCR underwent Nd:YAG laser revision. Through review of literature above outcome was compared with the efficacy of endoscopy revision nasal sinuses and secondary external operation. Results The 20 patients (21 eyes) underwent 23 times of failed external DCR. Osteotomy was detected in only 3 cases. Concrete reasons included absence of rhinostomy,membraneous nasolacrimal duct (NLD) obstruction,NLD stenosis,canalicular obstruction,cicatrix at rhinostomy,misplaced osteotomy,retained silk thread. A success of 52.38% was achieved. Mean follow-up period was 85.7months (range from 7 to 154 months). Conclusion As a main modality for NLD obstruction then in China,External DCR performed by non-lacrimal ophthalmologist might exert high risk of failure. Operation Grading and Entrance System should be implemented. Transcanalicular Nd:YAG laser revision is less successful than both endoscopic revision and repeat DCR.