Comparative analysis of treatment of patients with chronic dacryocystitis in early and late postoperative periods

Abstract

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.