Endoscopic Transnasal Dacryocystorhinostomy

經鼻腔內視鏡淚囊造瘻術

李家宏(Chia-Hung Lee) ； 李飛鵬(Fei-Peng Lee) ； 劉嘉銘(Chia-Ming Liu) ； 林凱南(Kai-Nan Lin) ； 黃弘孟(Hung-Meng Huang)

《慈濟醫學雜誌》 15卷2期 (2003/04) Pp. 91-95

https://doi.org/10.6440/TZUCMJ.200304.0091

摘要

目的：為了增加經外側淚囊鼻腔造 術(DCR)成功率和減少此術所致的不適，我們採用經鼻腔淚囊鼻腔造 術(ETDCR)來治療溢淚並研究其效果。材料與方法：從2000年1月至2001年12月，16位因鼻淚管阻塞造成溢淚的病人被轉介至本科接受ETDCR，11位病人是兩側阻塞，5位單側(共27側眼睛)。在4-mm，30熊躞隤瑣氻牏U，在中鼻甲前上側做1 cm的黏膜環切，並沿上頜竇線往下延伸至下鼻甲處，為了將淚囊暴露出來，我們用Stammberger-Saches鼻內電鑽及15韝犒q鑽去移除淚骨及上頜竇前凸，再以鐮刀將淚囊切開並外翻至鼻腔內。淚囊造口完成後，將一支架由上、下淚小管置入並於鼻內打結，留置6個月以上；術後每2個星期以內視鏡追蹤一次，兩次後則每月一次至術後6個月為止。結果：手術後6個月，我們將症狀改善的程度分成4個等級。22個眼睛是極佳(82%)，4個眼睛是尚可(14%)，1個眼睛是不變(4%)，唯一的併發症是眼眶周圍輕微瘀血。結論：我們認為ETDCR是外側DCR的一個替代手術方法，它有許多優點，如縮短手術時間、減少出血和保留眼輪匝肌的功能等。適用於內視鏡鼻腔手術熟練的外科醫師。(慈濟醫學 2003; 15:91-95)

關鍵字

淚囊鼻腔造瘻術 ； 經鼻腔內視鏡 ； 溢淚 ； 鼻淚管阻塞

並列摘要

Objectives: To improve the success rate and reduce the morbidity associated with the external approach to dacryocystorhinostomy (DCR), we adopted endoscopic transnasal DCR (ETDCR) for the treatment of epiphora and studied its efficacy. Materials and Methods: From January 2000 to December 2001, 16 patients with epiphora due to nasolacrimal duct obstruction were referred to our department for ETDCR. Eleven of the patients had bilateral obstruction and five had unilateral obstruction (27 eyes total). Under 4-mm, 30?nasoendoscopic guidance, a circumlinear mucosal incision was made 1 cm superior and anterior to the attachment of middle turbinate, extending downward along the maxillary line. Then, a Stammberger-Saches intranasal drill and a 15?curved intranasal drill were used to remove a piece of the lacrimal bone and maxillary frontal process to expose the lacrimal sac. A Silastic stent was then implanted and left for at least 6 months. Transnasal endoscopic follow-up was performed once every 2 week for the first month after stent placement and then once per month for 6 months. Results: Symptomatic improvement was categorized into four categories 6 months after surgery. Twenty-two (82%) eyes had excellent and four (14%) showed good improvement in symptoms. One (4%) eye was unchanged. The only complication was mild ecchymosis of the medial canthus area (12/27 eyes). Conclusion: We recommend ETDCR as an alternative to external DCR. It has many advantages, such as shortened surgical time, minimal bleeding and preservation of orbicularis oculi muscle function. It is suitable for surgeons well trained in endoscopic sinus surgery. (Tzu Chi Med J 2003; 15:91-95)

並列關鍵字

dacryocystorhinostomy ； transnasal endoscopy ； epiphora ； lacrimal obstruction