Minaiev O. Improved treatment efficacy in endonasal surgery of patients with obstruction of the nasolacrimal ducts in chronic purulent dacryocystitis

The dissertation is dedicated to the problem of increasing the efficiency of treatment of patients with chronic dacryocystitis by improving methods of diagnosis and endonasal endoscopic surgical treatment. The thesis is based of the complex clinical and instrumental study of the nasolacrimal passages, nasal cavity and paranasal sinuses, lacrimal drainage function, nasal mucosa in the dacryorhinostoma’ area and life quality of patients with chronic dacryocystitis before and after various modifications of endonasal endoscopic dacryocystorhinostomy (DCR). Patients of the investigated group (45 patients) underwent DCR according to the developed technique; patients of the control group (36 patients) underwent DCR according to the developed technique with placing of PVC-conductor into dacryorhinostoma’ zone; patients of the control group (28 patients, archival material) underwent DCR according to the traditional technique: with preservation and plastic conclusion of the excised mucosal flaps of the nasal cavity and lacrimal sac and with installation of a PVC-conductor. A method for determining the topographic and anatomical relationship of the lacrimal sac with the surrounding structures has been developed, making it possible to effectively plan the direction and volume of surgical intervention, form a "bone window" in the "optimal" location, quickly identify the lacrimal sac, resulting in less trauma and hemorrhaging of the surrounding tissues and better intraoperative visualization of the surgical field. The saving method of endonasal endoscopic surgical treatment of chronic purulent dacryocystitis has been developed, which allows to avoid stagnation and suppuration of tears, to carry out its passage evenly and unobstructed, contributing to minimize the scarring process on the dacryorhinostoma. It is established that application of the developed method of surgical treatment of chronic dacryocystitis contributed to significant decrease (more than 2 times) of mucous membrane edema and crusts formation as well as the number of patients with mucous discharge in the dacryorhinostoma’ area on the seventh day after operation in comparison with the control group (p<0,05). The use of the developed technique of endonasal endoscopic dacryocystorhinostomy has been found to achieve stable remission in 97,8% of patients with chronic dacryocystitis that is 12,1% higher in comparison with the control group (p<0,05). Combined application of the developed techniques of diagnostics and treatment of chronic dacryocystitis avoids local complications of the nasal cavity and the eye ball (p<0,05). The saving access to the lacrimal sac and fast and stable restoration of the lacrimal passage contributed to the statistically significant improvement of patients' quality of life (according to the SNOT-20 questionnaire) during the whole postoperative follow-up period (p<0,05).