Primary Nonendoscopic Endonasal Versus Delayed External Dacryocystorhinostomy in Acute Dacryocystitis
Primary Nonendoscopic Endonasal Versus Delayed External Dacryocystorhinostomy in Acute Dacryocystitis
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DOI：
10.1097/iop.0000000000000759
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发表时间：
2017-07-01
影响因子：
2
通讯作者：
Rath, Suryasnata
中科院分区：
文献类型：
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作者：
Jain, Saurabh;Ganguly, Anasua;Rath, Suryasnata
目的：急性泪囊炎的常规治疗包括药物治疗和选择性延迟泪囊鼻腔外造口术（ex - dcr）。本研究的目的是比较原发性非内窥镜鼻内泪囊鼻腔造口术（NEN-DCR）与常规治疗急性泪囊炎的疗效。方法：回顾性分析2011 - 2015年间所有连续出现的急性泪囊炎患者。A组患者在2周内接受了原发性NEN-DCR。B组包括接受常规治疗的年龄和性别匹配的患者。结果：纳入46例患者，每组23例。两组的平均年龄（45.2 +/- 14.7岁vs 47.5 +/- 14岁）和性别分布（A组女性17/23岁vs B组女性15/23岁）具有可比性。A组从首发到手术的平均时间为7.82 +/- 4.65天，B组为27.3 +/- 12天（p = 0.00001，独立T检验）。A组症状完全缓解的平均时间为21.4 +/- 6天，B组为38.69 +/- 15.8天（p = 0.000014，独立T检验）。丝裂霉素c的使用率（0.04%；17个月对14个月）和两组的平均随访时间（6.4个月对5.7个月）具有可比性。虽然两者的功能成功相似（20/23），但A组和B组的解剖成功分别为22/23和21/23。在EXT-DCR组中，并发症包括4例毁容性疤痕，3例复发性急性泪囊炎，1例点状外翻。结论：在急性泪囊炎中，与传统的延迟性EXT-DCR相比，原发性NEN-DCR可以更快地解决问题，促进早期康复，并具有相似的解剖和功能结果。
Purpose: Conventional treatment for acute dacryocystitis consists of medical management followed by elective delayed external dacryocystorhinostomy (EXT-DCR). The purpose of this study was to compare the outcome after primary nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) versus conventional treatment in acute dacryocystitis.Methods: Retrospective chart analysis of all consecutive patients of acute dacryocystitis presenting between 2011 and 2015 was performed. Group A had patients who underwent primary NEN-DCR within 2 weeks of presentation. Group B comprised age-and gender-matched patients who received conventional treatment.Results: Forty-six patients were included with 23 patients in each group. Mean age (45.2 +/- 14.7 vs. 47.5 +/- 14 years) and gender distribution (women 17/23 in group A vs. 15/23 in group B) in both groups were comparable. Mean duration from presentation to surgery was 7.82 +/- 4.65 days for group A versus 27.3 +/- 12 days for group B (p = 0.00001, independent T test). Mean time for complete resolution of symptoms was 21.4 +/- 6 days for group A versus 38.69 +/- 15.8 for group B (p = 0.000014, independent T test). Mitomycin-C usage (0.04%; 17 vs. 14) and mean follow up of both groups (6.4 vs. 5.7 months) were comparable. While functional success was similar (20/23) in both, anatomical success was seen in 22/23 and 21/23 in groups A and B, respectively. Complications included disfiguring scar in 4, recurrent acute dacryocystitis in 3, and punctal ectropion in one patient in the EXT-DCR group.Conclusions: Primary NEN-DCR leads to faster resolution facilitating earlier rehabilitation with comparable anatomical and functional outcomes compared with conventional delayed EXT-DCR in acute dacryocystitis.