| ObjectivesTo undergo concurrent nasal endoscopic sinus surgery and dacryocystorhin ostomy for patients with chronic dacryocystitis complicated withipsilateral chronic rhinosinusitis so as to observe the advantages of concurrent surgery and the influencing factors of clinical outcomes.MethodsA total of 87 chronic dacryocystitis patients complicated withipsilateral chronic rhinitis-sinusitis from January 2017 to March 2018 were enrolled in the study,undergoing concurrent nasal endoscopic sinus surgery and dacryocystorhinostomy,during which the silicone dilatation tube was not placed,and the nasal lacrimal sac mucosal flap was routinely preserved.All the patients complicated with chronic rhinosinusitis were in accordance with 1,2 stagings of Criteria(Haikou,1997),and those with two or more surgical history,severe systemic disease,and lost in follow-up were excluded.Conventional sinus coronal and axial CT,nasal endoscopy,lacrimal passage irrigation and lacrimal iodine angiography were performed for all patients before operation,and their anatomy structure of the lateral wall of the nasal cavity was carefully studied,nasal sinus lesions and the severity of lacrimal passage obstruction were evaluated.Another 34 patients who underwent staged surgery during2016 were collected as control group.The staged surgery included laparoscopic sinus surgery in the first stage,and endoscopic dacryocystorhinostomy of the nasal cavity in the second stage after reaching the clinical cure criteria for chronic rhinosinusitis in first stage.These patients were admitted into the hospital twice,and given anesthesia for two times,and underwent the two surgeries apart.The intraoperative blood loss and operation time of the two groups were recorded,and the hospital stay duration and hospitalization expense of the two groups were calculated.Postoperative nasal endoscopy recheck and lacrimal irrigation were performed in schedule.The nasal adhesion,scar formation and granulation tissue hyperplasia in postoperative stomy positions of the two groups were evaluated.The response rates of postoperative chronic dacryocystitis and rhinosinusitis were analyzed.Besides,the impact of categorical data(age,gender,and lesion side)on efficacy of concurrent surgery were evaluated.All analyses in the study were performed with the use of SPSS 22.0software,comparison of continuous data between the two groups was made by t test,and categorical data?~2 test.Results1.The intraoperative blood loss in the concurrent surgery group was(55.99±5.82)ml,and(54.85±2.39)ml in the staged operation group,but no significant between-group difference was observed(P>0.05);the operative time,hospital stay,and hospital expense in concurrent surgery group were(49.74±6.51)min,(6.17±1.75)d,and(13.10±3.40)thousand Yuan,respectively,and(59.59±5.74)min,(9.21±1.87)d,and(16.60±2.10)thousand Yuan,respectively,in the staged operation group,the indicators above showed significant differences in two groups(P<0.05).2.The postoperative response rate of chronic dacryocystitis and chronic rhinosinusitis were 93.10%(81/87),95.40%(83/87),respectively,in the concurrent surgery group,and 94.12%(32/34),97.01%(33/34),respectively,in the staged operation group after one-year follow-up,but no significant differences were seen between groups(P>0.05).The postoperative incidences of nasal adhesion,scar formation and granulation tissue hyperplasia was 16.09%(14/87)in the concurrent surgery group,and 14.71%(5/34)in the staged operation group,but had no significant differences in two groups(P>0.05).3.Clinical efficacy of concurrent surgery had no correlation with age,gender,and lesion side by univariate analysis(P>0.05),but was greatly affected by postoperative complications such as nasal adhesion,scar formation and granulation tissue hyperplasia in stomy locations(P<0.05).Conclusion1.Compared with staged operation group,concurrent surgery has satisfactory clinical efficacy after surgery for patients with chronic dacryocystitis complicated with chronic rhinosinusitis,which has the advantages of shorter hospital stay as well as operation time,and lower hospitalization expense.2.Postoperative complications(nasal adhesion,scar formation and granulation tissue hyperplasia in stomy locations)have greater influence on clinical efficacy of concurrent surgery.3.The incidence of postoperative complications can be reduced by detailed study ofanatomical structure of the lateral wall of the nasal cavity,mastery of intraoperative manipulation techniques,preservation of nasal lacrimal sac mucosal flap,and clinical efficacy of surgery can be enhanced by accurate mastery of surgical indications,postoperative periodic nasal endoscopy and lacrimal passage irrigation. |
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