Метою дослідження було розробити спосіб визначення топографо-анатомічного взаємозв’язку слізного мішка з оточуючими структурами та оцінити його ефективність при плануванні та виконанні ендоназальної ендоскопічної дакріоцисториностомії (ЕЕДЦРС). Досліджувану групу (1-а група) склали 45 пацієнтів з хронічним дакріоциститом (ХД), яким ЕЕДЦРС була здійснена за розробленою методикою, до групи порівняння (2-а група) було включено 36 хворих, яким після виконання ЕЕДЦРС за розробленою методикою в зону дакріориностоми встановлювали полівінілхлоридний провідник. До контрольної (3-ї) групи  увійшли 28 пацієнтів, яким ЕЕДЦРС виконувалась за загальноприйнятою методикою. Для оцінки інформативності методик проведення комп’ютерної томографії (КТ) СВШ і можливості ефективного застосування отриманих КТ-даних, пацієнти 1-ї та 2-ї груп були розподілені на 2 підгрупи: до 1А і 2А були включені пацієнти, яким КТ СВШ проводили за розробленою методикою, а хворим підгруп 1В і 2В – за традиційним алгоритмом. Гіперпневматизація клітин agger nasi виявлена у 14,7% обстежених, запальна патологія в навколоносових пазухах – у 38,5% (p>0,05). Слізна ямка розташовувалась на рівні переднього кінця середньої носової раковини (СНР) в 39,4 % випадках, допереду від нього – у 32,1%, а дозаду – в 14,7 %. У 13,8 % спостереженнях визначити відношення слізної ямки до СНР було утрудненим, ці випадки були в підгрупах 1В, 2В та в 3-й групі (p<0,05). Візуалізація хірургічного поля 1-2 ступеня в групах 1А та 2А була у понад 90 % пацієнтів, у групах 1В та 2В – менш ніж у 50 %, а в групі 3 – у 25 % хворих (p<0,05). Таким чином, анатомо-топографічні особливості СВШ необхідно визначати та враховувати при хірургічному лікуванні та спостереженні хворих з ХД. Розроблена методика проведення КТ із контрастуванням СВШ є ефективнішою в порівнянні з традиційною, а виконання хірургічного втручання при її застосуванні – ощадливим.

Chronic dacryocystitis (CD) is a common pathology of the lacrimal ducts. The search for the optimal method of endonasal endoscopic dacryocystorhinostomy (EEDCR), which would give a quick, high-quality and lasting effect, as well as a lower percentage of disease relapses, remains relevant. The aim: to analyze the effectiveness of treatment of patients with chronic dacryocystitis in the early and late postoperative periods with the use of various modifications of EEDCR. Materials and methods: The study group (1st group) consisted of 45 patients with CD, who underwent EED-CR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCRa polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method: with preservation and plastic placement of mucous flaps and with the installation of a PVC conductor. Patients of 1stand 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. In the postoperative period, the severity of lacrimation was assessed according to the Munk scale, the degree of visualization of the dacryorhinostoma was determined, and the lacrimal function was investigated by advanced West nasolacrimal test under endoscopic control. The final treatment efficacy was assessed 1 year after surgery. Results: The best results when tested according to the Munk scale were recorded in subgroups 1A and 1B with a statistically significant difference from subgroups 2A, 2B and 3rd group throughout the early postoperative period and 1 month after surgery (p<0.05).During the observation period of 3, 6 and 12 months, that is, after the removal of the implant from the lacrimal ducts, there was an improvement in the results in patients of subgroups 2A, 2B and 3rd group, and the difference from subgroups 1A and 1B was statistically insignificant (p>0.05).In the early postoperative period, visualization of the dacryorhinostoma was good in all patients. In the late postoperative period, the best results were in subgroup 1A, the worst in 3rd group, but without a statistically significant difference due to a small sample of patients (p>0.05).Reliably better results of the lacrimal function were obtained in subgroups 1A and 1B already from the 3rd day after surgery, as well as in the subsequent periods of the early postoperative period and 1 month after surgery (p<0.05).In subsequent periods of the late postoperative period, this indicator worsened in all clinical groups, the best results were in subgroup 1A, the worst in 3rd group, but due to a small sample of patients, there was no statistically significant difference (p>0.05).The maximum paces of deterioration in visualization of dacryorhinostoma and lacrimal function were observed from the 3rd to 6th months after the operation. The proportion of positive treatment results in 1st group was 97.8%, in 2nd group – 94.4%, and in 3rd group – 85.7%, while the difference between groups 1 and 3 was statistically significant (p<0,05). Conclusions: The developed technique of endonasal endoscopic dacryocystorhinostomy allows achieving stable remission in 97.8% of patients with chronic dacryocystitis, and the use of CT of the lacrimal ducts according to the developed technique allows to improve the results of surgical treatment.

Relevance. Effective treatment of chronic dacryocystitis (CD) remains an urgent problem of modern ophthalmology and rhinology. When studying this issue, not enough attention is always paid to complications. Objective – to analyze the existing complications in the surgical treatment of patients with СD. Material and methods. The study group (1st group) consisted of 45 patients with CD, who underwent endonasal endoscopic dacryocystorhinostomy (EEDCR) according to the developed own method, the comparison group (2nd group) included 36 patients who after performing the developed EEDCR a polyvinyl chloride (PVC) conductor was installed in the area of the dacryonostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the traditional method: with the preservation and plastic placement of mucous flaps and with the installation of PVC-conductor. Patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography (CT) of the lacrimal ducts in the preoperative period according to the developed method and patients of subgroups 1B and 2B – according to the traditional algorithm. Statistical analysis was performed using the licensed program MedCalc (MedCalc Software bvba, Ostend, Belgium; 2017). Results. In patients of subgroups 2A, 2B, and group 3 in the period of 1.5 months after surgery, local complications of the eyeball were recorded: epiphora during implant wearing, severe conjunctivitis, prolapse and displacement of the implant, granulation in the lower lacrimal duct, ectopia of the lower lacrimal point. No such complications were observed in patients of subgroups 1A and 1B. In patients of subgroups 1B, 2B, and group 3 in the early postoperative period were recorded varying degrees of swelling of the lower eyelid, as well as nosebleeds after removal of tampons. No such complications were observed in patients of subgroups 1A and 2A, and the difference between the groups was statistically significant (p <0.05). Conclusion. CT of the lacrimal ducts and EEDCR according to the developed methods are effective and allow their combined use to avoid local complications from the nasal cavity and eyeball.

Purpose – to study the prevalence of endonasal pathology in patients with chronicdacryocystitis (CD) and to justify the expediency of simultaneous operations in suchpatients.Material and methods. The study included 109 patients with CD, who were examinedand operated on in 2004-2014 at the Department of Otorhinolaryngology Faculty ofInternship and Postgraduate Education "Donetsk National Medical University of theMinistry of Health of Ukraine". Examination of patients included consultation with anophthalmologist, lavage of the lacrimal ducts, endoscopy of the nasal cavity, computedtomography. All patients underwent tearing by performing endonasal endoscopicdacryocystorhinostomy (EEDCR).Results. Endonasal pathology was detected in 85.3% of patients: curvature of the nasalseptum - in 71.6% of patients, hypertrophy of the inferior turbinate - in 59.6%, bulloushypertrophy of the middle turbinate - in 5.5%, hypertrophy of the uncinate process- in 6.4%, hyperpneumatization of Agger nasi cells - in 14.7% of patients. The mostcommon combination was curvature of the nasal septum and hypertrophy of the inferiorturbinates - in 56.0% of cases. Inflammatory pathology in the paranasal sinuses wasin 38.5% of cases: ethmoiditis - in 26.6% of patients, maxillary sinusitis - in 13.8%,sphenoiditis - in 1.8% of patients. In 94.6% of patients, the correction of intranasalpathology was performed simultaneously with EEDCR. In 6.4% of these patients therewere complications - nosebleeding after removal of tampons. Simultaneous operationsdid not significantly increase the percentage and variants of complications comparedwith isolated endonasal operations.Conclusion. The vast majority of patients with chronic dacryocystitis have pathologyof the nasal cavity and paranasal sinuses, which may contribute to the developmentof dacryocystitis and relapse of the disease after operation. Surgical correction ofconcomitant endonasal pathology in patients with chronic dacryocystitis should beperformed simultaneously with endonasal endoscopic dacryocystorhinostomy.

The aim. To develop a method for endonasal endoscopic dacryocystorhinostomy (EEDCR) and evaluate its effectiveness in monitoring patients in the early postoperative period. Materials and methods. The study group (1st group) consisted of 45 patients with chronic dacryocystitis (CD), who underwent EEDCR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCR, an implant was installed in the dacryorhinostoma zone. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method. Patients of groups 1 and 2 were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. Reliably the best results of restoring lacrimation function were in subgroups 1A and 1B already from the 3rd day of observation after surgery, as well as in the subsequent periods of observation. The worst values of lacrimation function were recorded in the control clinical group with a statistically significant difference from other groups (p<0.05). When comparing the results of treatment of subgroups 1A with 1B and 2A with 2B, the best indicators were observed in subgroups 1A and 2A, but due to the small sample of patients, statistical significance in the differences could not be achieved (p>0.05). Results. A method of EEDCR has been developed, a comparative analysis of groups of patients according to the above indicators has been performed when observing patients in the early postoperative period. On the first day after surgery, the mean score of the severity of lacrimation according to the Munk scale significantly decreased in all groups and gradually decreased on the 7th day and after 2 weeks (p<0.05). Significantly better indicators were in subgroups 1A and 1B in the entire early postoperative period (p<0.05). The degree of edema of the mucosa of the dacryorhinostoma zone and the middle nasal meatus at all periods of observation was the lowest in subgroup 1A from 3rd day and in each subsequent period of observation with a statistically significant difference from other groups (p<0.05). On the 7th day, significantly more patients with mucous discharge in the area of dacryorhinostoma and middle nasal meatus were observed in subgroup 2B and in 3rd group (p<0.05), and significantly better results were noted in subgroup 1A, where more than 2/3 patients had no mucous discharge. Reliably the best results of restoring lacrimation function were in subgroups 1A and 1B already from the 3rd day of observation after surgery, as well as in the subsequent periods of observation. The worst values of lacrimation function were recorded in the control clinical group with a statistically significant difference from other groups (p<0.05). When comparing the results of treatment of subgroups 1A with 1B and 2A with 2B, the best indicators were observed in subgroups 1A and 2A, but due to the small sample of patients, statistical significance in the differences could not be achieved (p>0.05). Conclusions. The developed EEDCR method complies with the principles of sparing surgery, is effective in the treatment of patients with CD, while there is a faster rate of recovery of the lacrimal function and mucosa, improves the quality of life of patients