内镜下泪囊鼻腔吻合术治疗急性泪囊炎急性发作期的疗效

Effect of endoscopic dacryocystorhinostomy in treatment of acute dacryocystitis with acute attack stage

摘要:

目的 评估内镜下泪囊鼻腔吻合术（En-DCR）治疗急性泪囊炎急性发作期的疗效。方法 纳入2016年9月－2020年12月于温州医科大学附属眼视光医院行En-DCR的66例成年急性泪囊炎急性发作期（发作时间小于72 h）的患者。入院后常规静脉抗生素治疗，并在入院24 h内行En-DCR，术后静脉抗生素和激素治疗2 d。术后随访12个月，记录患者急性炎症消退时间（泪囊区肿胀消退、内眦部疼痛消退和皮肤红斑消退）、泪道再造术成功率和并发症发生率。结果 En-DCR术后泪囊区肿胀消退时间1～5 d，平均（2.97±0.96）d；内眦部疼痛消退时间2～7 d，平均（3.79±1.31）d；内眦部皮肤红斑消退时间3～14 d，平均（6.98±3.59）d。术后12个月泪道再造术成功率为93.44%（57/61）。未出现急性泪囊炎复发、内眦部破溃、眶内脓肿和眶蜂窝织炎等并发症。结论 对于成年急性泪囊炎的急性发作期即刻行En-DCR，效果好，术后成功率高，无皮肤破溃和感染扩散等并发症发生，值得临床推广应用。

Abstract:

Objective To investigate the effect of endoscopic dacryocystorhinostomy (En-DCR) as a treatment for patients with acute attack stage of acute dacryocystitis.Methods From September 2016 to December 2020, 66 adults presenting with acute attack stage of acute dacryocystitis (the time of symptom on-set within the last 72 h) were included in this study. All the patients underwent En-DCR less than 24 h after admission under the use of systematic antibiotic. Postoperative intravenous antibiotics and hormones were administered for 2 d. Postoperative follow-up evaluations included time to external acute inflammation resolution (swelling in the lacrimal sac area subsides, pain in the inner canthus subsides, and skin erythema subsides), reconstruction of continuity of lacrimal duct success rate, and complication rates.Results The time of resolution of swelling in the lacrimal sac area subsides after surgery was 1 ~ 5 d, mean (2.97 ± 0.96) d. The time of resolution of pain in the inner canthus subsides after surgery was 2 ~ 7 d, mean (3.79 ± 1.31) d. The time of resolution of erythema after surgery was 3 ~ 14 d, mean (6.98 ± 3.59) d. The success rate of reconstruction of continuity of lacrimal duct at 12 months after surgery was 93.44% (57/61). There was no compilations such as acute dacryocystitis recurrence, skin fistulization, intraorbital abscess formation and orbital cellulitis during the follow-up.Conclusion For adult acute dacryocystitis, immediate En-DCR has good effect, high postoperative success rate, and no complications such as skin rupture and infection spread, which is worthy of clinical promotion.