Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Eksternal Dakriyosistorinostomide U Şekilli Flep Tekniğinin Sonuçlarının Değerlendirilmesi: Bir Retrospektif Olgu Serisi
Evaluation of the Results of the U-Shaped Flap Technique in External Dacryocystorhinostomy: A Retrospective Case Series
Nurşen ÖNCEL ACIRa , Osman SAYINa , Raşit DİLEKa
aKonya Şehir Hastanesi, Göz Hastalıkları Kliniği, Konya, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(4):245-51
doi: 10.5336/ophthal.2024-103876
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada, kliniğimizde U şekilli flep tekniği ile yaptığımız eksternal dakriyosistorinostomi (DSR) ameliyatlarını, hastaların erken ve geç dönem takip sonuçlarını analiz etmeyi ve cerrahi başarıyı etkileyen faktörleri tartışmayı amaçladık. Gereç ve Yöntemler: Bu çalışmaya, nazolakrimal kanal tıkanıklığı nedeniyle U şekilli flep tekniği ile eksternal DSR uygulanan 59 hastanın 61 gözü dâhil edildi. Cerrahi sonrasında, lakrimal irrigasyon ile nazolakrimal kanalın açık olması anatomik başarı olarak kabul edilirken, epiforanın olmaması fonksiyonel başarı olarak kabul edildi. Ayrıca cerrahi süresi, kemik ostiyum çapı, postoperatif takip süresi, intraoperatif ve postoperatif komplikasyonlar kaydedildi. Bulgular: Cerrahi sırasındaki ortalama hasta yaşı 55,7±13,4 (aralık, 25-77) yıl idi. Çalışmamızda 17 (%28,8) erkek ve 42 (%71,1) kadın hasta mevcuttu. Ortalama cerrahi süresi 43,4±6,9 (aralık, 30-60) dk idi. Ortalama kemik ostiyum çapı 12×17 mm idi. Hiçbir olguda intraoperatif fulminan seyirli kanama ya da flep kaybı gibi ciddi bir intraoperatif komplikasyon gelişmedi. Cerrahi sonrası ortalama takip süresi 8,8±1,9 (aralık, 6-16) ay idi. Anatomik başarı 59 gözde sağlandı ve başarı oranı %96,7 idi. Fonksiyonel başarı ise 55 gözde sağlandı ve başarı oranı %90,2 idi. Anatomik başarının sağlanamadığı 2 (%3,2) olguda, endoskopik DSR ile revizyon cerrahisi uygulandı ve epifora tamamen düzeldi. Sadece 1 (%1,6) olguda, postoperatif 1. ayda tüp malpozisyonu gelişti. Sonuç: U şekilli flep ile eksternal DSR, nazolakrimal kanal tıkanıklıklarının tedavisinde etkili ve güvenli bir cerrahi prosedürdür. Bu yöntemde, kemik pencerenin uygun büyüklük ve lokasyonda yapılmasının, büyük mukozal flepler oluşturulmasının ve kanaliküllerden itibaren pasaj açıklığının silikon tüp ile sağlanmasının cerrahi başarıyı artırdığını düşünüyoruz.

Anahtar Kelimeler: Eksternal dakriyosistorinostomi; epifora; kemik ostium; silikon tüp; U flep tekniği
ABSTRACT
 Objective: In this study, we wanted to analyze the external dacryocystorhinostomy (DCR) surgeries performed with the Ushaped flap technique in our clinic, the early and late follow-up outcomes of the patients, and to discuss the factors affecting surgical success. Material and Methods: This study included 61 eyes of 59 patients who underwent external DCR with the U-shaped flap technique due to nasolacrimal duct obstruction. After surgery, the open nasolacrimal passage with lacrimal irrigation was accepted as anatomical success, while the absence of epiphora was accepted as functional success. Additionally, surgery time, bone ostium diameter, postoperative follow-up time, intraoperative and postoperative complications were recorded. Results: The mean patient age at the time of surgery was 55.7±13.4 (range, 25-77) years. There were 17 (28.8%) male and 42 (71.1%) female patients. The mean surgery time was 43.4±6.9 (range, 30-60) minutes. The mean bone ostium diameter was 12×17 mm. No serious intraoperative complications such as intraoperative fulminant bleeding or flap loss occurred in any case. The mean follow-up period after surgery was 8.8±1.9 (range, 6-16) months. Anatomical success was achieved in 59 eyes, with a success rate of 96.7%. Functional success was achieved in 55 eyes, with a success rate of 90.2%. In 2 cases (3.2%) where anatomical success was not achieved, revision surgery was performed with endoscopic DCR, and the epiphora was completely resolved. Tubal malposition developed in only 1 case (1.6%) in the first postoperative month. Conclusion: External DCR with the U-shaped flap technique is an effective and safe surgical procedure in the treatment of nasolacrimal duct obstructions. In this method, we think that making the bone window in the proper size and location, creating large mucosal flaps, and providing the passage opening from the canaliculi with a silicone tube improves surgical success.

Keywords: External dacryocystorhinostomy; epiphora; bone ostium; silicone tube; U-shaped flap technique
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