丝裂霉素C在小梁咬切器辅助下泪点息肉切除术中的应用
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摘要
目的探讨在小梁咬切器辅助下泪点息肉切除术中应用丝裂霉素C的疗效。方法选取2009年1月至2012年6月在中国人民解放军第三二二医院诊治的118例下泪点息肉患者为研究对象,将研究对象进行分组:观察组62例62眼(丝裂霉素C联合小梁咬切器辅助下泪点息肉切除术)和对照组56例56眼(小梁咬切器辅助下泪点息肉切除术)。随访2 a观察并比较两组泪点息肉治疗后的临床效果及息肉复发情况。结果术后早期观察组发生泪小点水肿17眼、角膜荧光素点染4眼,对照组发生泪小点水肿15眼、角膜荧光素点染3眼,两组并发症发生率比较差异无统计学意义(P>0.05);两组均未发生其他严重并发症。术后随访观察2a,观察组有效率(治愈率+好转率)为96. 77%,对照组有效率为87. 50%,2组差异无统计学意义(P> 0. 05)。观察组泪点息肉复发率为4. 84%,对照组为19. 64%,差异有统计学意义(P <0.05)。结论丝裂霉素C能有效降低泪点息肉复发,提高手术成功率,值得在临床上推广。
Objective To discuss the clinical effect of mitomycin C in the excision of lacrimal polyp with trabecular cutter. Methods From January 2009 to June 2012,118 patients with lacrimal polyp were selected as subjects in the PLA Hospital of 322.These patients were divided into observation group(62 patients 62 eyes), in which the patients receives the excision of lacrimal polyp with trabecular cutter and mitomycin C,and control group(56 patients 5 6 eyes), in which the patients were only given the excision of lacrimal polyp with trabecular cutter. All patients were postoperatively followed up for 2 years. Their clinical effects were compared after the treatment. Results During the initial postoperative period, there were seventeen eyes of lacrimal puncta edema and four eyes of positive corneal fluorescein in the observation group, and there were fifteen eyes of lacrimal puncta edema and three eyes of positive corneal fluorescein in the control group, with no different significance (P > 0. 05). Serious complications had not occurred in the two groups. All patients continued to be followed up for two years. In the observation group, the effective rate (cure rate +improvement rate) was 96. 77%,while the recurrence rate was 4.84%. In the control group, the effective rate was 87.50% while the recurrence rate was 19.64%. And the effective rate of the observation group was not significantly different from that of the control group(P > 0.05), but the recurrence rate in the observation group was significantly lower than that of the control group (P < 0. 05). Conclusion Mitomycin C can prevent the recurrence of lacrimal polyp and increase the success rate of operation, so it is suitable for clinical practices.
Objective To discuss the clinical effect of mitomycin C in the excision of lacrimal polyp with trabecular cutter. Methods From January 2009 to June 2012,118 patients with lacrimal polyp were selected as subjects in the PLA Hospital of 322.These patients were divided into observation group(62 patients 62 eyes), in which the patients receives the excision of lacrimal polyp with trabecular cutter and mitomycin C,and control group(56 patients 5 6 eyes), in which the patients were only given the excision of lacrimal polyp with trabecular cutter. All patients were postoperatively followed up for 2 years. Their clinical effects were compared after the treatment. Results During the initial postoperative period, there were seventeen eyes of lacrimal puncta edema and four eyes of positive corneal fluorescein in the observation group, and there were fifteen eyes of lacrimal puncta edema and three eyes of positive corneal fluorescein in the control group, with no different significance (P > 0. 05). Serious complications had not occurred in the two groups. All patients continued to be followed up for two years. In the observation group, the effective rate (cure rate +improvement rate) was 96. 77%,while the recurrence rate was 4.84%. In the control group, the effective rate was 87.50% while the recurrence rate was 19.64%. And the effective rate of the observation group was not significantly different from that of the control group(P > 0.05), but the recurrence rate in the observation group was significantly lower than that of the control group (P < 0. 05). Conclusion Mitomycin C can prevent the recurrence of lacrimal polyp and increase the success rate of operation, so it is suitable for clinical practices.
引文
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[3]TIAN Z L,WANG Z H,LIANG L.Surgical observation of point polyp[J].Chin J Ophthomal Otorhinolaryngol,2003,3(5):325.田振兰,王志红,梁玲.泪点息肉手术观察[J].中国眼耳鼻喉科杂志,2003,3(5):325.
[4]WANG J Q,HUANG K.Morphological observation and grading and staging of lacrimal point polyps[J].J Clin Ophthalmol,2009,17(1):80-81.王建强,黄凯.泪点息肉的临床形态学观察及分级、分期探讨[J].临床眼科杂志,2009,17(1):80-81.
[5]LIU Z G.Dignosis of dry eye[J].Chin J Ophthalmol,2002,38(5):318-320.刘祖国.干眼的诊断[J].中华眼科杂志,2002,38(5):318-320.
[6]WANG X R,LI Z D,WANG C.Investigation and analysis on antibiotics application during perioperative period of cataract surgery in ophthalmology department[J].Clin Med J,2014,12(5):40-43.王向荣,李忠东,王川.我院白内障患者围手术期抗菌药物使用调查分析[J].临床药物治疗杂志,2014,12(5):40-43.
[7]TIAN J J,KONG H,LIU F L.Clinical analysis of laser lacrimal point plasty therapy combined with lacrimal intubation for lacrimal point stenosis[J].Int Eye Sci,2011,11(7):1247-1249.田锦锦,孔慧,刘夫玲.激光泪小点成形术/泪小点切开术联合泪道置管治疗泪小点狭窄[J].国际眼科杂志,2011,11(7):1247-1249.
[8]JIN L S,LI W J,LU J,WU C Z,CUI R Z.Investigation&analysis of the incidence of dacryon polyposis&the relevant causing factors in the frontier korean minority populated area of China[J].Chin JPract Ophthalmol,2005,23(11):1249-1250.金龙山,李文吉,鲁杰,吴成哲,崔仁哲.边疆少数民族地区泪点息肉患病率及相关因素调查分析[J].中国实用眼科杂志,2005,23(11):1249-1250.
[9]ESMAELI B,VALERO V,AHMADI M A,BOOSER D.Canalicular stenosis secondary to docetaxel(taxotere):a newly recognized side effect[J].Ophthalmology,2001,108(5):994-995.
[10]ZHANG J X,DENG H W,HUANG Y T,YANG Y,YE L,LIANGH.Clinical research of puncta lacrimalis[J].Int Eye Sci,2010,10(4):788-790.张敬先,邓宏伟,黄一涛,杨媛,叶琳,梁海.泪点炎的临床观察研究[J].国际眼科杂志,2010,10(4):788-790.
[11]DUAN H J,SU X H,ZHANG L F,LIU Y H,XU Y.A method of clipation for the treatment of lacrimal punctum polyps[J].Chin JTraum Disabil Med,2008,16(5):59.段惠静,苏晓华,张林凤,刘英豪,徐瑶.一剪法治疗泪小点息肉[J].中国伤残医学,2008,16(5):59.
[12]KASHKOULI MB,BEIGI B,MURTHY R.Acquired external punctal stenosis:etiology and associated findings[J].Am J Ophthalmol,2003,136(6):1079-1084.
[13]VEIRS E R.The lacrimal system:Clinical Application[M].New York:Grune Press,1955:46.
[14]RUBEN C M.Alternative to the 3-snip operation for lacrimal drainage insufficiency[J].Br J Ophthalmol,1958,42(10):626-627.
[15]ZHANG J G,BU Z Y,ZHU L,WANG L Y,QING H L,YU X F.Curative effect observation on improvement polypectomy combined Nd∶YAG laser therapy for acrimal punctum polyps[J].Chin JPract Ophthalmol,2014,32(6):757-760.张俊鸽,卜占云,祝磊,王丽娅,庆惠玲,余晓菲.改良泪点息肉切除联合Nd∶YAG激光治疗泪点息肉疗效观察[J].中国实用眼科杂志,2014,32(6):757-760.
[16]HAN Y J,LI F Q.The selection of punctal plugs in laser resection for the treatment of polyps of lacrymal punctum[J].Chin J Ocul Traum Occupat Eye Dis,2015,37(9):709-710.韩永杰,李富强.泪点息肉激光切除术中使用泪点塞的选择[J].中华眼外伤职业眼病杂志,2015,37(9):709-710.
[17]SHANG N,LUAN C S,HU D Y.Clinical diagnosis and surgical treatment of lacrimal point polyps[J].Heilongjiang Med Pharmac,2007,30(1):37.尚宁,栾春生,胡东燕.泪小点息肉的临床诊断及手术治疗[J].黑龙江医药科学,2007,30(1):37.
[18]LI H R,ZHAO Y,ZHANG J.Application of mitomycin C in nasal endoscopic dacryocystorhinostomy[J].Int Eye Sci,2012,12(3):568-569.李洪润,赵影,张娇.丝裂霉素C在鼻内镜下泪囊鼻腔吻合术中的应用分析[J].国际眼科杂志,2012,12(3):568-569.
[19]YOU Y A,SUN X C,FANG C T,LIAO Z S.Different concentration of mytomycin C in dacryocystorhinostomy[J].Chongqing Med,2007,36(12):1157-1160.游逸安,孙新成,方春庭,廖志苏.不同浓度丝裂霉素C在泪囊鼻腔吻合术应用中的比较[J].重庆医学,2007,36(12):1157-1160.
[20]HAN D M.New progress in otolaryngology and neck surgery[M].Beijing:People’s Medical Publishing House,2008:378-379.韩德民.耳鼻咽喉头颈外科学新进展[M].北京:人民卫生出版社,2008:378-379.
[21]ZHAO M,WU T X.A study on the physiological mechanism of tear excrection[J].Chin J Ophthalmol Otorhinolaryngol,2001,1(6):183-186.赵敏,吴彤霞.泪液排泄生理机制的研究[J].中国眼耳鼻喉科杂志,2001,1(6):183-186.
[22]NAGASHIMA K,KIDO R.Relative roles of upper and lower lacrimal canaliculi in normal tear drainage[J].Jpn J Ophthalmol,1984,28(3):259-262.
[2]SONG C,MA Z Z.Ophthamology surgery[M].Beijing:People’s Military Medical Press,2008:206-209.宋琛,马志中.眼科手术学[M].北京:人民军医出版社,2008:206-209.
[3]TIAN Z L,WANG Z H,LIANG L.Surgical observation of point polyp[J].Chin J Ophthomal Otorhinolaryngol,2003,3(5):325.田振兰,王志红,梁玲.泪点息肉手术观察[J].中国眼耳鼻喉科杂志,2003,3(5):325.
[4]WANG J Q,HUANG K.Morphological observation and grading and staging of lacrimal point polyps[J].J Clin Ophthalmol,2009,17(1):80-81.王建强,黄凯.泪点息肉的临床形态学观察及分级、分期探讨[J].临床眼科杂志,2009,17(1):80-81.
[5]LIU Z G.Dignosis of dry eye[J].Chin J Ophthalmol,2002,38(5):318-320.刘祖国.干眼的诊断[J].中华眼科杂志,2002,38(5):318-320.
[6]WANG X R,LI Z D,WANG C.Investigation and analysis on antibiotics application during perioperative period of cataract surgery in ophthalmology department[J].Clin Med J,2014,12(5):40-43.王向荣,李忠东,王川.我院白内障患者围手术期抗菌药物使用调查分析[J].临床药物治疗杂志,2014,12(5):40-43.
[7]TIAN J J,KONG H,LIU F L.Clinical analysis of laser lacrimal point plasty therapy combined with lacrimal intubation for lacrimal point stenosis[J].Int Eye Sci,2011,11(7):1247-1249.田锦锦,孔慧,刘夫玲.激光泪小点成形术/泪小点切开术联合泪道置管治疗泪小点狭窄[J].国际眼科杂志,2011,11(7):1247-1249.
[8]JIN L S,LI W J,LU J,WU C Z,CUI R Z.Investigation&analysis of the incidence of dacryon polyposis&the relevant causing factors in the frontier korean minority populated area of China[J].Chin JPract Ophthalmol,2005,23(11):1249-1250.金龙山,李文吉,鲁杰,吴成哲,崔仁哲.边疆少数民族地区泪点息肉患病率及相关因素调查分析[J].中国实用眼科杂志,2005,23(11):1249-1250.
[9]ESMAELI B,VALERO V,AHMADI M A,BOOSER D.Canalicular stenosis secondary to docetaxel(taxotere):a newly recognized side effect[J].Ophthalmology,2001,108(5):994-995.
[10]ZHANG J X,DENG H W,HUANG Y T,YANG Y,YE L,LIANGH.Clinical research of puncta lacrimalis[J].Int Eye Sci,2010,10(4):788-790.张敬先,邓宏伟,黄一涛,杨媛,叶琳,梁海.泪点炎的临床观察研究[J].国际眼科杂志,2010,10(4):788-790.
[11]DUAN H J,SU X H,ZHANG L F,LIU Y H,XU Y.A method of clipation for the treatment of lacrimal punctum polyps[J].Chin JTraum Disabil Med,2008,16(5):59.段惠静,苏晓华,张林凤,刘英豪,徐瑶.一剪法治疗泪小点息肉[J].中国伤残医学,2008,16(5):59.
[12]KASHKOULI MB,BEIGI B,MURTHY R.Acquired external punctal stenosis:etiology and associated findings[J].Am J Ophthalmol,2003,136(6):1079-1084.
[13]VEIRS E R.The lacrimal system:Clinical Application[M].New York:Grune Press,1955:46.
[14]RUBEN C M.Alternative to the 3-snip operation for lacrimal drainage insufficiency[J].Br J Ophthalmol,1958,42(10):626-627.
[15]ZHANG J G,BU Z Y,ZHU L,WANG L Y,QING H L,YU X F.Curative effect observation on improvement polypectomy combined Nd∶YAG laser therapy for acrimal punctum polyps[J].Chin JPract Ophthalmol,2014,32(6):757-760.张俊鸽,卜占云,祝磊,王丽娅,庆惠玲,余晓菲.改良泪点息肉切除联合Nd∶YAG激光治疗泪点息肉疗效观察[J].中国实用眼科杂志,2014,32(6):757-760.
[16]HAN Y J,LI F Q.The selection of punctal plugs in laser resection for the treatment of polyps of lacrymal punctum[J].Chin J Ocul Traum Occupat Eye Dis,2015,37(9):709-710.韩永杰,李富强.泪点息肉激光切除术中使用泪点塞的选择[J].中华眼外伤职业眼病杂志,2015,37(9):709-710.
[17]SHANG N,LUAN C S,HU D Y.Clinical diagnosis and surgical treatment of lacrimal point polyps[J].Heilongjiang Med Pharmac,2007,30(1):37.尚宁,栾春生,胡东燕.泪小点息肉的临床诊断及手术治疗[J].黑龙江医药科学,2007,30(1):37.
[18]LI H R,ZHAO Y,ZHANG J.Application of mitomycin C in nasal endoscopic dacryocystorhinostomy[J].Int Eye Sci,2012,12(3):568-569.李洪润,赵影,张娇.丝裂霉素C在鼻内镜下泪囊鼻腔吻合术中的应用分析[J].国际眼科杂志,2012,12(3):568-569.
[19]YOU Y A,SUN X C,FANG C T,LIAO Z S.Different concentration of mytomycin C in dacryocystorhinostomy[J].Chongqing Med,2007,36(12):1157-1160.游逸安,孙新成,方春庭,廖志苏.不同浓度丝裂霉素C在泪囊鼻腔吻合术应用中的比较[J].重庆医学,2007,36(12):1157-1160.
[20]HAN D M.New progress in otolaryngology and neck surgery[M].Beijing:People’s Medical Publishing House,2008:378-379.韩德民.耳鼻咽喉头颈外科学新进展[M].北京:人民卫生出版社,2008:378-379.
[21]ZHAO M,WU T X.A study on the physiological mechanism of tear excrection[J].Chin J Ophthalmol Otorhinolaryngol,2001,1(6):183-186.赵敏,吴彤霞.泪液排泄生理机制的研究[J].中国眼耳鼻喉科杂志,2001,1(6):183-186.
[22]NAGASHIMA K,KIDO R.Relative roles of upper and lower lacrimal canaliculi in normal tear drainage[J].Jpn J Ophthalmol,1984,28(3):259-262.
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