目的：探究内镜下泪囊鼻腔吻合术中的最佳造口高度。方法：前瞻性随机对照研究。选取2019-01/2020-08于武汉爱尔眼科医院汉口医院行内镜下泪囊鼻腔吻合术的229例255眼患者作为研究对象，包括急性泪囊炎、慢性泪囊炎及鼻泪管阻塞三类患者，每类患者均随机分为A、B、C、D四组，7号泪道探针自上泪点进针探入泪道造口骨孔，将探针头部紧贴骨孔上端，以探针与内外眦水平连线之间的夹角角度α的度数大小进行分组，A组α1：-15°～+15°； B组α2：+16°～+30°； C组α3：+31°～+45°； D组α4：+46°～+75°。所有患者均随访至术后3mo，记录术中出血量、手术时长及术后疗效。结果：术后3mo，A组的术中出血量均较B、C、D三组更多，且手术时间最长； D组手术时长均较A、B、C三组更短(均P<0.05)，B、C两组手术时长对比无差异(P>0.05)； B组的术后疗效明显优于A、C、D三组，D组的术后疗效与A、B、C三组对比最差，均有差异(均P<0.05)，A、C两组术后疗效对比无差异(P>0.05)。结论：探针角度为+16°～+30°的区间范围是内镜下泪囊鼻腔吻合术的最佳造口高度。

AIM: To investigate the optimal height of anastomotic in endoscopic dacryocystorhinostomy.METHODS: This was a prospective randomized controlled study. Totally 229 patients(255 eyes)who were treated with endoscopic dacryocystostomy in Hankou Eye Hospital of Wuhan Aier from January 2019 to August 2020 were selected as the research objects. Including three types of patients: acute dacryocystitis, chronic dacryocystitis and nasolacrimal duct obstruction. Each type of patients were randomly divided into four groups: A, B, C and D. The No.7 lacrimal passage probe was inserted from the upper lacrimal puncta into the bone hole of lacrimal passage stoma. The probe head was close to the upper end of the bone hole, and the angle between the probe and the horizontal line of inner and outer canthus was measured α. Group A α1: -15°to +15°; Group B α2: +16°to +30°; Group C α3: +31°to +45°; Group D α4: +46°to +75°. All patients were followed up to 3mo postoperative. The amount of intraoperative blood loss, operation time and postoperative efficacy were recorded.RESULTS: At 3mo postoperative, the intraoperative blood loss in Group A was more than that in Groups B, C and D, and the operation time was the longest. The operation time of Group D was shorter than that of Groups A, B and C(all P<0.05), but there was no significant difference between Groups B and C(P>0.05). The curative effect of Group B was the best and the Group D was the worst(all P<0.05), and there was no significant difference between Group A and Group C(P>0.05).CONCLUSION: The probe angle from +16°to +30°was the optimal height of anastomotic in endoscopic dacryocystorhinostomy.

湖北省卫生健康委员会联合基金项目(No.WJ2019H318); 湖北省武汉市医学科研面上重点项目(No.WX19A03)