Endoscopic endoscopic internal capsule nasal anastomosis combined with lacrimal duct dilation and drainage tube in the treatment of dacryocystitis with lacrimal duct obstruction: A randomized controlled trial of 120 patiants
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摘要:
目的 探讨鼻内镜下内囊鼻腔吻合术（EES-DCR）联合泪道扩张引流管治疗慢性泪囊炎合并泪道阻塞患者的效果。 方法 选取我院2018年1月~2020年1月拟接手术治疗的慢性泪囊炎合并泪道阻塞患者120例作为研究对象，采用前瞻性随机试验研究将患者分为观察组和对照组，60例/组。观察组采用EES-DCR联合泪道扩张引流管治疗，对照组采用EES-DCR联合美乐胶治疗。对比两组患者术后不同时间的临床效果评价、手术时间、下睑缘上方泪液弧高度、溢泪程度、泪膜破裂时间、泪液分泌实验、患眼的疼痛程度及并发症情况。 结果 术后3月评价，观察组的治愈率91.67%、好转率8.33%，对照组治愈率86.67%、好转率11.67%、无效率1.67%，观察组和对照组临床疗效差异无统计学意义（P>0.05）；术后6月评价，观察组的治愈率88.33%、好转率11.67%，对照组治愈率73.33%、好转率25.00%、无效率1.67%，观察组的临床疗效优于对照组且差异具有统计学意义（P < 0.05）；术后3月评价，观察组的下睑缘上方泪液弧高度正常率88.33%、偏高率8.33%、较高率3.33%，对照组下睑缘上方泪液弧高度正常率76.67%、偏高率15.00%、较高率8.33%，两组的下睑缘上方泪液弧高度差异无统计学意义（P>0.05）；术前，观察组和对照组的VAS评分差异无统计学意义（P>0.05），术后1周，观察组的VAS评分低于对照组，差异有统计学意义（P < 0.05）；术前，观察组和对照组的溢泪程度评分、泪膜破裂时间、泪液分泌实验差异无统计学意义（P>0.05），术后1月，观察组的溢泪程度、泪液分泌实验低于对照组，泪膜破裂时间大于对照组，且差异具有统计学意义（P < 0.05）。 结论 EES-DCR联合泪道扩张引流管治疗慢性泪囊炎合并泪道阻塞患者术后效果优于EES-DCR联合美乐胶，值得临床开展运用。 -
关键词:
- 鼻内镜下内囊鼻腔吻合术 /
- 泪道扩张引流管 /
- 慢性泪囊炎 /
- 泪道阻塞
Abstract:Objective To explore the effect of endoscopic endoscopic internal capsule nasal anastomosis (EES-DCR) combined with lacrimal duct dilation and drainage tube in the treatment of patients with chronic dacryocystitis and lacrimal duct obstruction. Methods We selected 120 patients with chronic dacryocystitis combined with lacrimal duct obstruction in our hospital from January 2018 to January 2020. A prospective randomized trial study was used to divide the patients into an observation group and a control group, 60 cases/group. The observation group was treated with EES-DCR combined with lacrimal duct dilation and drainage tube. The control group was treated with EES-DCR combined with melamine. The clinical effect evaluation, operation time, and tear arc height above the lower eyelid margin were compared between the two groups at different times after surgery. The degree of tearing, tear film rupture time, tear secretion experiment, pain degree of the affected eye and complications were compared. Results Evaluation 3 months after the operation, the observation group had a cure rate of 91.67%, an improvement rate of 8.33%, and a control group had a cure rate of 86.67%, an improvement rate of 11.67%, and an inefficiency of 1.67%. There was no significant difference in clinical efficacy between the observation group and the control group (P>0.05). 6 months after the operation, the observation group had a cure rate of 88.33%, an improvement rate of 11.67%, a control group had a cure rate of 73.33%, an improvement rate of 25.00%, and an inefficiency of 1.67%. The observation group's clinical efficacy was better than the control (P < 0.05). 3 months after the operation, the observation group had a normal rate of 88.33%, a high rate of 8.33%, and a higher rate of 3.33% of the tear arc above the lower eyelid margin. The normal rate of the tear arc above the eyelid margin was 76.67%, the high rate was 15.00%, and the higher rate was 8.33%. There was no significant difference in the height of the tear arc above the lower eyelid margin between the two groups (P>0.05). There was no significant difference in the VAS score of the control group (P>0.05). One week after the operation, the VAS score of the observation group was lower than that of the control group and the difference was significant (P < 0.05). There were no significant differences in the degree score, tear film rupture time, and tear secretion experiment (P>0.05). One month after surgery, the degree of tearing and tear secretion experiment in the observation group were lower than those in the control group, and the tear film rupture time was longer than the control group (P < 0.05). Conclusion The postoperative effect of EES-DCR combined with lacrimal duct dilation and drainage tube in the treatment of patients with chronic dacryocystitis and lacrimal duct obstruction is better than that of EES-DCR combined with melody -
图 1 EES-DCR联合泪道扩张引流管治疗的影像学表现
A：术前显示泪道红肿、阻塞；B：术后3月复查，可见吻合口开放良好、泪道冲洗通畅、患者溢泪症状消失.
Figure 1. Imaging of EES- DCR combined with lacrimal duct dilation and drainage tube treatment.
表 1 两组患者的一般资料对比
Table 1. Comparison of general data of the two groups of patients (n=60)
一般资料 观察组 对照组 t/x2 P 年龄（岁，Mean±SD） 47.3±7.2 49.1±8.6 -1.243 0.216 BMI(kg/m2, Mean±SD) 23.9±2.5 24.2±2.8 -0.619 0.537 病稈（月，Mean±SD） 28.5±8.5 27.2±7.7 0.878 0.382 性別[n(%)] 1.087 0.297 男 13(21.67) 18(30.00) 女 47(78.33) 42(70.00) 患侧分布[n(%)] 0.835 0.361 左侧 26(43.33) 31(51.67) 右侧 34(56.67) 29(48.33) 吸烟[n(%)] 1.815 0.178 是 17(28.33) 24(40.00) 否 43(71.67) 36(60.00) 饮酒[n(%)] 1.386 0.239 是 16(26.67) 22(36.67) 否 44(73.33) 38(63.33) 高血压[n(%)] 1.046 0.306 是 11(18.33) 7(11.67) 否 49(81.67) 53(88.33) 
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表 2 术后3月两组患者临床疗效比较
Table 2. Comparison of clinical efficacy between the two groups of patients 3 months after operation[n=60, n(%)]
组別 治愈 好转 无效 观察组 55(91.67) 5(8.33) 0(0.00) 对照组 52(86.67) 7(11.67) 1(1.67) Z -0.901 P 0.367
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表 3 术后6月两组患者临床疗效比较
Table 3. Comparison of clinical efficacy between the two groups of patients 6 months after operation[n=60, n(%)]
组別 治愈 好转 无效 观察组 53(88.33) 7(11.67) 0(0.00) 对照组 44(73.33) 15(25.00) 1(1.67) Z -2.104 P 0.035
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表 4 两组患者术后3月的下睑缘上方泪液弧高度比较
Table 4. Comparison of the tear arc height above the lower eyelid margin between the two groups of patients 3 months after surgery[n=60, n(%)]
组別 正常(≤0.1 mm) 偏高(0.1~0.2 mm) 较高（≥0.2 mm) 观察组 53(88.33) 5(8.33) 2(3.33) 对照组 46(76.67) 9(15.00) 5(8.33) Z -1.696 P 0.090
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表 5 两组患者手术前后的疼痛程度比较
Table 5. Comparison of the pain degree before and after the operation between the two groups (n=60, Mean±SD)
组別 术前 术后1周 术后1月 观察组 5.51±1.30 2.64±0.89 1.22±0.41 对照组 5.28±1.41 3.08±0.95 1.34±0.48 t 0.929 -2.618 -1.472 P 0.355 0.010 0.144
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表 6 两组溢泪程度、泪膜破裂时间、泪液分泌实验比较
Table 6. Experimental comparison of the degree of tearing, tear film rupture time, and tear secretion between the two groups (n=60, Mean±SD)
组别 溢泪程度（分） 泪膜破裂时间（s） 泪液分泌实验（mm） 术前 术后1月 术前 术后1月 术前 术后1月 观察组 4.10±0.76 1.15±0.37 7.48±1.58 12.76±1.93 17.84±2.65 12.48±2.00 对照组 4.02±0.82 1.40±0.41 7.82±1.61 11.80±2.05 17.51±2.80 13.74±2.51 t 0.554 -3.506 -1.168 2.641 0.663 -3.041 P 0.580 0.001 0.245 0.009 0.509 0.003
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表 7 两组患者手术并发症率比较
Table 7. Comparison of surgical complication rates between the two groups (n=60)
组別 面部肿胀 鼻粘膜出血 并发症率[n(%)] 观察组 1 1 2(3.33) 对照组 4 3 7(11.67) x2 3.003 P 0.083
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