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Abstract：
OBJECTIVE: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction.
METHODS: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test.
RESULTS: Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported.
CONCLUSIONS: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.
METHODS: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test.
RESULTS: Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported.
CONCLUSIONS: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.
摘要：
目的：鼻内镜下球囊辅助泪滴成形术是一种微创手术方法，可在泪囊鼻腔造口术失败并复发后应用。
方法：在耳鼻咽喉科，圣拉斐尔医院，米兰(意大利),2016年12月至2020年10月,14例患者在泪囊鼻腔造口术(鼻外和内镜下)失败后接受了经鼻球囊辅助泪滴成形术.常规术前检查包括泪腺疾病的多学科研究，其中包括与鼻内窥镜检查相关的原发性眼科和耳鼻喉科就诊，如果需要，增加了放射学检查。手术方法包括狭窄的鼻造口术的气动扩大，在原发性泪囊鼻腔造口术中产生，使用高压经鼻球囊导管。当口在灌溉时获得专利时，就考虑了解剖学上的成功，而功能成功被认为是在功能测试中解决了溢泪或游离泪流。
结果：在包括的14例患者中，平均随访19.5个月（范围13-51个月），100%的患者实现了解剖成功,85.7%(12/14)的患者实现了功能成功.手术时间9～28min，平均18min，无并发症发生。
结论：经鼻球囊辅助泪滴成形术是一种微创手术方法，可治疗泪囊鼻腔造口术失败，长期疗效可靠稳定。没有手术后的并发症，这种创新手术的主要特点是成功率高、手术时间短。
方法：在耳鼻咽喉科，圣拉斐尔医院，米兰(意大利),2016年12月至2020年10月,14例患者在泪囊鼻腔造口术(鼻外和内镜下)失败后接受了经鼻球囊辅助泪滴成形术.常规术前检查包括泪腺疾病的多学科研究，其中包括与鼻内窥镜检查相关的原发性眼科和耳鼻喉科就诊，如果需要，增加了放射学检查。手术方法包括狭窄的鼻造口术的气动扩大，在原发性泪囊鼻腔造口术中产生，使用高压经鼻球囊导管。当口在灌溉时获得专利时，就考虑了解剖学上的成功，而功能成功被认为是在功能测试中解决了溢泪或游离泪流。
结果：在包括的14例患者中，平均随访19.5个月（范围13-51个月），100%的患者实现了解剖成功,85.7%(12/14)的患者实现了功能成功.手术时间9～28min，平均18min，无并发症发生。
结论：经鼻球囊辅助泪滴成形术是一种微创手术方法，可治疗泪囊鼻腔造口术失败，长期疗效可靠稳定。没有手术后的并发症，这种创新手术的主要特点是成功率高、手术时间短。
