頁籤選單縮合
題 名 | 經鼻內視鏡淚囊鼻腔造口術=Transnasal Endoscopic Dacryocystorhinostomy |
---|---|
作 者 | 張光正; 蔡易錚; 林友祺; 江秉穎; | 書刊名 | 臺灣耳鼻喉頭頸外科雜誌 |
卷 期 | 46:5 2011.09-10[民100.09-10] |
頁 次 | 頁226-233 |
分類號 | 416.753 |
關鍵詞 | 淚囊鼻腔造口術; 溢淚; 鼻淚管阻塞; Dacryocystorhinostomy; Epiphora; Lacrimal obstruction; Mitomycin-C; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:隨著鼻腔內視鏡的應用,更多人用鼻內視鏡處理鼻淚管阻塞,本研究探討近年本醫院施行鼻腔內視鏡淚囊鼻腔造口術(transnasal endoscopic dacryocystorhinostomy, TEDCR)的手術方法,並比較與分析mitomycin-C在TEDCR的臨床效果。方法:自1994年到2009年,42名經診斷為後天性鼻淚管阻塞引起之溢淚症,經保守治療無效,評估後實施TEDCR。全身麻醉下,以內視鏡在中鼻甲外前上側沿上頷竇線往下延伸至下鼻甲附著處,在中鼻甲外前上側翻起一1 x 1 cm的ㄈ-字型黏膜瓣(muco-periosteal flap),並敲開淚骨(lacrimal bone)及部分上頷骨額突(frontal process of maxilla),露出淚囊完成造口後,將一矽質管(CIS tube),留置5~6個月。追蹤並統計成功率與各種併發症。結果:共42名病人,男性9名,女性33名,均接受TEDCR。有7例術後CIS tube自行脫落,1例術後淚小點感染,4例輕微鼻出血,2例眼內皆瘀青。術中22名未用mitomycin-C浸泡淚囊造口,20名術中使用0.2 mg/mL mitomycin-C浸潤造口3分鐘。在移除矽質管時,未使用mitomycin-C的平均成功率約76%,使用mitomycin-C的平均成功率約75%,兩組無明顯差異(chi-square test, p-value = 0.8629)。結論:本院TEDCR手術結果與其他文獻相去不遠。此手術治療因鼻淚管阻塞引起之淚溢症,具備顏面美觀的保持、高成功率、低併發症以及眼輪匝肌和內眥肌腱的幫浦功能得以保存等優點,對於鼻內其他疾病可一併處理,實可做為國內耳鼻喉科醫師的常規手術項目。術中矽質管支架的使用對手術成功率的提升仍有疑慮,且有副作用發生的可能。而mitomycin-C在TEDCR的使用是安全的方法,但在不會造成手術時間冗長或影響傷口癒合的前提下,mitomycin-C是否能提高手術成功率,仍需要更進一步的研究與探討。 |
英文摘要 | BACKGROUND: As the technical advancement of nasal endoscopy, transnasal endoscopic dacryocystorhinostomy (TEDCR) is becoming popular for the nasolacrimal duct obstruction. This study showed the clinical experiences in TEDCR performed in our Hospital. .And we also analyzed the role of mitomycin C during the TEDCR.METHODS: This is a retrospective study from 1994 to 2009. 42 patients with epiphora which induced by acquired nasolacrimal duct obstruction were referred for TEDCR after limited response to medical treatment. Under general anesthesia, we incised the nasal l11ucosa harvesting a 1 X 1 posteriorly based muco-periosteal flap from the anterior superior aspect of axilla of middle turbinate to the maxillary line and extended the line down to the insertion of inferior turbinate in order to expose the lacrimal bone. After removal of lacrimal bone and lower part of the frontal process of the maxilla, the silicone tube (CIS tube) was inserted through the inferior and superior punctums with 2 ends were tied in the nasal cavity. The posteriorly based ll1uco-periosteal flap was then used to cover the bare bone. The tube then remained in place for 5~6 months. RESULTS: There were 9 male and 33 fem ale in a total of 42 acquired nasolacrimal duct obstruction of patients underwent TEDCR. Post-operatively, the silicone tube extrusion spontaneously were noted in 7 patients , mild epistaxis in 4 patients, infection of the wound in 1 case, ecchymosis of medial canthus in 2 cases. During surgery, 20 patients received mitomycin C soakings, while the other 22 did not. Success rates at the fifth month of follow-up were 75% and 76%, respectively. There is no significant difference of improvement in the group receiving mitomycin-C soaking.CONCLUSIONS: The surgical outcome of our series is comparable to the previous literature. TEDCR preserves facial appearance with low complication rates and preserves the pumping function by medial palpebral ligament and orbicularis oculi muscle. The endoscopic approach provides excellent visualization and management of intranasal structures. TEDCR is indeed an alternative to the traditional extra-nasal procedure. It has doubts in using the CIS tube for stenting because of the possibility of side effect. Relatively, the using of mitomycin-C is safe. But it needs advanced study about the adequate dose and infiltration time during the TEDCR without long-winded surgery or delayed wound healing. |
本系統中英文摘要資訊取自各篇刊載內容。