| Objective:To investigate the feasibility of the surgery of YAG laser–assisted dacryocystorhinostomy from lacrimal puncta to treat chronic dacryocystitis by comparing with the surgery of dacryocystorhinostomy from nasal cavity .Methods:The cases were from E.N.T. department and Ophthalmology of Second Affiliated Hospital of Jilin University,dating from Dec 2008 to Aug 2010. The age was ranged from 21 years to 67 years (mean 48.3 years).There were 21 female and 52 male. A total of 68 cases with chronic dacryocystitis were divided into 2 groups randomly, to receive 2 types of dacryocystorhinostomy. Group A including 36 cases(36 eyes) received the surgery of YAG laser–assisted dacryocystorhinostomy from lacrimal puncta .Group B including 32 cases(32 eyes) received the surgery of dacryocystorhinostomy from nasal cavity with nasal endoscope.The analysis of two surgical management:(1)Time: from the moment of taking out the cotton fleexe to the second of taking away the surgical instrument after hemostasis.(2)The hemorrhage during the surgery.(3)The expenses of the treatment:Group A was outpatient local anesthesia surgery,and all the expenses was involved. Group B was performed under general anesthesia,and all the expenses apart from the expenses for the general anesthesia was involved.(4)The comparison of the treatment effect:①the epiphora level:level 0 is no epiphora.level 1 is intermittent tearing,and wiping tears twice a day.level 2 is wiping tears 3 to 4 times a day.level 3 is wiping tears 5 to 10 times a day.level 4 is wiping tears more than 10 times a day,but not all the time.level 5 is constant epiphora.②the treatment level: a,Healing:succeed in the pore forming located in the front-end of ethmoid cornua and paries lateralis of nasal cavity, epithelization,free from symptoms such as tearing and suppuration,and unobstructed after irrigation of lacrimal passage or compression. b,Improvement: succeed in the pore forming located in the front-end of ethmoid cornua and paries lateralis of nasal cavity, epithelization but experience intermittent tearing,less symptoms and unobstructed after irrigation of lacrimal passage or compression. c,No improvement:fail in the pore forming,still suffere from the symptoms,obstructed after irrigation of lacrimal passage or compression and epiphora.(5) Postoperative complications:the narrow pore forming,the failing in the pore forming, the wrong location of the pore forming and the injury of lacrimal passage and nasal septum.Results: The follow up form was checking up with nasal endoscope,irrigation of lacrimal passage and questionnaire.(1)A statistica- -lly significant effect was observed at the time of surgeries(P<0.01),the time of Group A was less than Group B.(2)A statistically significant effect was observed atthe hemorrhageduring the surgery(P<0.01),hemorrhage of Group A was less than Group B.(3)A statistically significant effect was observed at the expenses(P<0.01),the expenses of Group A was less than Group B.(4) No statistically significant effect was observed at the treatment effect. Conclusions: the surgery of dacryocystorhinostomy from nasal cavity has been used for years clinically and been mastered by many ENT doctors and oculists. For the eutherapeutic effectiveness, it has been a mature surgery. There is no statistically significant effect was observed between the effort and postoperative complications of the surgery of YAG laser–assisted dacryocystorhinostomy from lacrimal puncta and the surgery of dacryocystorhinostomy from nasal cavity.However, the former is better than the later in time of the surgery,hemorrhage and expenses.So the surgery of YAG laser–assisted dacryocystorhinostomy from lacrimal puncta is well worthy disseminating and applying. |
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