Analysis of the Impact of Surgical Technique on Postoperative Outcomes in Dacryocystorhinostomy

Öz

This study aims to evaluate and compare the surgical outcomes of external (exDCR), endoscopic endonasal (enDCR), and transcanalicular laser dacryocystorhinostomy (tcDCR) in patients with acquired nasolacrimal duct obstruction. In this retrospective study, 130 patients were categorized into three groups: exDCR (n=67), enDCR (n=31), and tcDCR (n=32). Surgical success was defined as resolution of epiphora at the 12-month follow-up, patent lacrimal irrigation, and endoscopic confirmation of a patent rhinostomy. The effects of potential confounding variables, including age, sex, and systemic comorbidity, on surgical outcomes were evaluated using multivariable logistic regression analysis. Success rates were found to be 89.6% for exDCR, 80.6% for enDCR, and 50.0% for tcDCR. While exDCR and enDCR demonstrated comparable efficacy (p = 0.509), the success rate of tcDCR was significantly lower compared to the other techniques (p = 0.002). In multivariate analysis, surgical technique was identified as the only independent predictor of success, whereas age, sex and systemic comorbidity were not significantly associated with outcomes. In conclusion, exDCR and enDCR provide high and comparable success rates, whereas tcDCR, despite being less invasive, is associated with significantly lower long-term success.

Anahtar Kelimeler

• Dacryocystorhinostomy
• nasolacrimal duct obstruction
• external DCR
• endoscopic DCR
• laser DCR.

Dakriyosistorinostomide Cerrahi Tekniğin Ameliyat Sonuçlarına Etkisinin Analizi

Öz

Bu çalışmada, edinsel nazolakrimal kanal tıkanıklığı olan hastalarda eksternal (exDSR), endoskopik (enDSR) ve transkanaliküler lazer dakriyosistorinostomi (tcDSR)’nin cerrahi sonuçlarının karşılaştırması amaçlanmıştır. Çalışmaya dahil edilen 130 hasta, exDSR (n=67), enDSR (n=31) ve tcDSR (n=32) olmak üzere üç gruba ayrılmıştır. Cerrahi başarı, 12 aylık takip sonunda epiforanın düzelmesi, lavaj ile pasajın açık olması ve endoskopik muayenede rinostominin patent olarak izlenmesi şeklinde tanımlanmıştır. Yaş, cinsiyet ve sistemik komorbidite gibi potansiyel karıştırıcı değişkenlerin cerrahi sonuçlar üzerindeki etkisi çok değişkenli lojistik regresyon analizi ile değerlendirilmiştir. Başarı oranları exDSR için %89,6; enDSR için %80,6 ve tcDSR için %50,0 olarak saptanmıştır. ExDSR ve enDSR sonuçları arasında istatistiksel olarak anlamlı fark izlenmezken (p = 0,509), tcDSR grubunun başarı oranı diğer gruplara göre anlamlı düzeyde düşük saptanmıştır (p = 0,002). Çok değişkenli analizde, cerrahi teknik başarının bağımsız belirleyicisi olarak saptanmış olup, yaş ve cinsiyetin sonuçlar üzerinde anlamlı bir etkisi izlenmemiştir. Sonuç olarak, exDSR ve enDSR yüksek ve benzer başarı oranları sağlarken, tcDSR daha az invaziv olmasına rağmen anlamlı derecede düşük uzun vadeli başarı ile ilişkilidir. 

Anahtar Kelimeler

• nazolakrimal kanal tıkanıklığı
• eksternal DSR
• endoskopik DSR
• lazer DSR
• Dakriyosistorinostomi

Kaynakça

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