Artikel
Endoscopic laser assisted dacryocystorhinostomy
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Veröffentlicht: | 30. März 2016 |
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Gliederung
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ENT Department of First Pavlov State Medical University of Saint Petersburg has 10-years experience of laser endoscopic dacryocystorhinostomy. We apply laser for mucosa removal in cases of thin bone and medial position of lacrimal sack for bone window formation and for lacrimal sack perforation. In situations of thick bone we use cold instruments, drill or chisel. Laser used in continuous mode with 6-8W, fiber shape can be easily changed by different handpieces for better application on lateral nasal wall. Totally 51 patients were operated during 3 years. Among them: 7 male, 44 female. Middle age: 57,5 from 26 to 83. Middle operation time is 22 min. Revision surgery made after previous laser endoscopic interventions was performed in 9 patients. In 3 patients third endoscopic intervention was effective, in one case with image guidance application. In 2 patients endoscopic laser dacryocystorhinostomy was effective after previous surgery with external approach. No major complications been observed in our group of patients. Most common complication is eyelid oedema – in 8 cases, nasal blockage – in 11 cases, intraoperative bleeding – in 3 cases. In patients with nasal mucosa oedema also adrenomymetics were recommended for 3 days. Our experience in laser endoscopic dacryocystorhinostomy shows a high effectiveness of this approach in a treatment of dacryocystorhinostenotic patients. Firstly, this procedure is not painful, less traumatic, with no significant morbidity in postop period and can be recommended in elderly patients. This method can be fulfilled in different causes of stenosis, but most easily it can be applied in posttraumatic stenosis. Thin laser fiber can be used in narrow noses without carrying-out any additional septal or turbinate correction.
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