Effect Of Different Absorbable Anastomotic Stoma Packing Materials On Endonasal Endoscopic Dacryocystorhinostomy

Objective:Three different absorbable materials,self-crosslinking sodium hyaluronic gel,Nasopore,and gelfoam,were used to pack the anastomotic stoma during endonasal endoscopic dacryocystorhinostomy(En-DCR).To observe the effect of these materials on the therapeutic effect of En-DCR.Methods:From June 2019 to December 2020,72 patients(90 eyes)with chronic dacryocystitis treated in Affiliated Eye Hospital of Nanchang University were included in this study.All selected patients underwent a comprehensive ophthalmic examination,including vision,intraocular pressure,irrigation of lacrimal passage,CT dacryocystography,and endoscopic examination of nasal cavity.They are divided into three groups according to the type of packing material.In group A,26patients(32 eyes)were treated with self-crosslinking sodium hyaluronic gel,22 patients in group B(27 eyes)were treated with Nasopore,and 24 in group C(31eyes)were treated with gelfoam.All patients in the three groups underwent En-DCR and were followed up regularly.Postoperative comfort level,bleeding and complications(scar proliferation,granuloma formation,anastomotic stoma synechiae)were compared among the three groups.The cure rate and effective rate were compared by observing the patients’ epiphora,pyorrhea,epithelization of anastomotic stoma and the result of illumination of lactic passage.Spss19.0statistical software was used for statistical analysis of the data.Age and course of disease were compared by one-way ANOVA,P<0.05 was considered statistically significant;postoperative comfort level and bleeding were compared by Kruskal Wallis h test,P<0.05 was considered statistically significant;gender,complication rate and cure rate were compared by chi square test,P < 0.05 was considered statistically significant.The effective rate was compared by Fisher exact probability method,P<0.05 was considered statistically significant,two of them are compared,P < 0.0167 was considered statistically significant.The correlation between complications and curative effect was analyzed by RR relative risk statistical method Results:In this study,72 patients(90 eyes)were selected,including 26 cases(32 eyes)of self-crosslinking sodium hyaluronic gel group,22 cases(27 eyes)of Nasopore group,24 cases(31 eyes)of gelfoam group,and All patients were followed up for 6months.1.Situation comparison: there were no significant differences in age,gender and course of disease among the three groups(P > 0.05).2.Comfort level and bleeding: postoperative comfort of self-crosslinking sodium hyaluronic gel group and gelfoam group was better than that of Nasopore group(P<0.05),but bleeding was more serious than that of Nasopore group(P<0.05).The difference between self-crosslinking sodium hyaluronic gel group and gelfoam group was not statistically significant(P>0.05).3.Complication rate:The scar proliferation rate and granuloma formation rate of the self-crosslinking sodium hyaluronic gel group were lower than those of the Nasopore group(P<0.05).There was no meaningful statistical difference in the rate of scar proliferation rate and granuloma formation rate between other groups(P>0.05).The rate of anastomotic stoma adhesion rate in self-crosslinking sodium hyaluronic gel group and Nasopore group was higher than that in gelfoam group(P <0.05),but there was no significant difference between self-crosslinking sodium hyaluronic gel group and Nasopore group(P > 0.05).4.Curative effect:The cure rate of lacrimal system reconstruction was 96.88%in self-crosslinking sodium hyaluronic gel group,88.89% in Nasopore group and93.55% in gelfoam group.There was no meaningful statistical difference between the three groups(P>0.0167).The effective rate of lacrimal system reconstruction was 90.63% in self-crosslinking sodium hyaluronic gel group,55.56% in Nasopore group and 87.10% in gelfoam group.There was significant statistical difference between self-crosslinking sodium hyaluronic gel group and Nasopore group or between Nasopore group and gelfoam group(P<0.05),however,there was no meaningful statistical difference between group A and C(P>0.05).5.Correlation between complications and curative effect: scar proliferation was the most likely cause of invalid operation(RR = 21.471,95% confidence interval 2.679-172.057),granuloma formation was the most likely cause of incomplete cure(RR = 6.000,95% confidence interval 2.727-13.202).Compared with no granuloma formation,the relative risk of ineffective operation was not statistically significant(RR = 1.750,95% confidence interval: 0.345-8.870).There was no significant difference in the relative risk of invalid operation(RR = 2.750,95% confidence interval 0.595-12.707)and incomplete cure(RR = 1.604,95%confidence interval 0.716-3.594)between patients with and without anastomotic stoma adhesion.Conclusion:Self-crosslinked sodium hyaluronic gel is a simple,comfortable and efficient anastomotic stoma packing materials,which has better comprehensive ability among the three materials and is worthy of clinical application.The effective rate and cure rate of gelfoam is similar to that of Self-crosslinked sodium hyaluronic gel.When Self-crosslinked sodium hyaluronic gel is difficult to obtain,gelfoam can be used selectively.The postoperative comfort and complications were poor,and the cure rate was low,it is not recommended among the three.