Surgical Outcomes of Hammer-Chisel and Drill Techniques to Create Superior Bony Ostium During Endoscopic Dacryocystorhinostomy

Hye Jin Lee, Jun Ho Oh, Yong Koo Kang, Dai Woo Kim, Byeong Jae Son
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Abstract

Purpose: We introduce a “cold steel” hammer-chisel technique for endoscopic dacryocystorhinostomy, then compare postoperative outcomes between this technique and a drill technique.Methods: This study included 191 patients (297 eyes) with nasolacrimal duct stenoses or obstructions who underwent endoscopic dacryocystorhinostomy using the hammer-chisel or drill technique. Surgical outcomes were compared via follow-up screening for epiphora and anatomical complications such as granuloma and fibrous membrane formation, canalicular obstruction, and synechiae.Results: Postoperative anatomical complications occurred in 29 eyes (18.6%) in the hammer-chisel group and 51 eyes (36.2%) in the drill group (p = 0.001). The anatomical failure rate was higher in the drill group [28 eyes (19.9%)] than in the hammer-chisel group [18 eyes (11.5%); p = 0.038]. Functional failure was observed in 13 eyes (8.3%) in the hammer-chisel group and 13 eyes (9.2%) in the drill group (p = 0.787). The mean operation time was significantly longer in the drill group (35.5 ± 10.4 minutes vs. 25.4 ± 9.1 minutes) (p < 0.001).Conclusions: During endoscopic dacryocystorhinostomy, osteotomy with a hammer-chisel is more successful and leads to fewer complications than osteotomy with a drill.
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内镜下泪囊鼻腔造口术中采用锤凿和钻孔技术创建上骨膜的手术效果
目的:我们介绍了一种用于内窥镜泪囊鼻腔吻合术的 "冷钢 "锤凿技术,然后比较了这种技术和钻孔技术的术后效果:这项研究纳入了 191 位鼻泪管狭窄或阻塞的患者(297 只眼),他们都使用锤凿或钻孔技术接受了内窥镜泪囊鼻腔吻合术。通过随访筛查眼外窥和解剖并发症(如肉芽肿和纤维膜形成、管腔阻塞和虹膜瘤),对手术结果进行了比较:锤凿组有 29 只眼睛(18.6%)出现术后解剖并发症,钻孔组有 51 只眼睛(36.2%)出现术后解剖并发症(P = 0.001)。钻孔组解剖失败率[28 眼(19.9%)]高于锤凿组[18 眼(11.5%);P = 0.038]。锤凿组有 13 只眼睛(8.3%)功能失败,钻孔组有 13 只眼睛(9.2%)功能失败(p = 0.787)。钻孔组的平均手术时间明显更长(35.5 ± 10.4 分钟对 25.4 ± 9.1 分钟)(p < 0.001):在内窥镜下进行泪囊鼻腔造口术时,使用锤凿截骨比使用钻头截骨更成功,并发症更少。
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