新生儿泪囊炎泪道探通时机评估  

Evaluotion of lacrimal passage probing in congenital nasolacrimal duct obstruction

作　　者：于刚[1] 吴倩[1] 蔺琪[1] 李子江[1] 全晓杰[1] 漆雅[1] 陶荣[1] 白大勇[1] 张诚朋[1] 

机构地区：[1]北京儿童医院眼科,100045

出　　处：《中国实用眼科杂志》2007年第12期1335-1337,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的评估新生儿泪囊炎最佳手术探通时机,探讨手术成功的相关因素。方法随机选择眼科门诊2004年4月至2006年2月2448例2～60个月新生儿泪囊炎病例。根据儿童年龄分为2m～4m,5m～12m,13m～60m三组分别观察。对保守治疗2周无效的患儿采用一体式泪道冲洗探通针一次性完成泪道探通手术,手术前后连续使用妥布霉素,生理盐水,氟美松行泪道冲洗3d-5d,对于术后泪道不通患儿手术后1w复行泪道再次探通,二次探通失败者手术后1m后再行泪道探通术。治愈标准为无溢泪,无分泌物,泪道冲洗通畅。术后仍然流泪,伴分泌物,泪道冲洗不畅为无效。结果2个月～4个月组治愈率（98.44%）,5个月～12个月组治愈率（96.47%）,13个月～60个月组治愈率（90.56%）3组比较,患儿年龄越小,手术探通治愈率越高,差异有统计学意义（P〈0.01）;其中2个月～4个月组1次探通成功率（3.02%）;5个月～12个月组一次探通成功率（6.42%）;13个月～60个月组一次探通成功率（9.12%）;3个年龄组相比,随着年龄增加,多次探通率明显增加,具有统计学意义（P〈0.05）。结论新生儿泪囊炎,年龄越小手术治愈率越高,2周以上保守治疗无效者,应该早期行泪道探通手术。手术前后采用抗生素和激素连续冲洗泪道及采用改良新款一体式冲洗探通针对于手术的成功至关重要。Objective Congenital nasolacrimal duct obstruction is very common among pediatric cases. Past history and optimal timing of treatment were investigated. Method Between 1994 and 2006, there were 2448 congenital dacryocystitis cases treated with lacrimal passage probing, aged 2 months to 60 months. All the cases were grouped in three categories： 2 to 4 months, 5 to 12 months, and 13 to 60 months. Probing and irrigation were performed after two weeks of no improvement with conservate treatment. Probing had been performed second time after one week and the third time probing followed one month later. Successful cases were defined with absence of symptoms and signs like tearing, crusting, and discharge, regurgitation with pressure on the lacrimal sac. Result 1206 of 1225 （98.44%）patients success by probing aged 2 to 4 months, 1067 of 1106 （96.47%） patients success aged 5 to 12 months, 288 of 318 （90.59%） patients success aged 13 to 60 months.（P〈0.01） .And the success patients by once probing in three age group is 1169（96.9%）, 996（93.3%） and 259（89.9%）.（P〈0.05）.Conclusion Age 2 to 4 months is the best timing for first time probing, and the success rate declined as the patients become older. Corticosteroid and antibiotic serve a vital role in treating these cases with performing irrigation and probing. In fact, probing is also very important in the aspect of technique.

关 键 词：泪囊炎 泪道探通 新生儿 探通时机 

分 类 号：R777.23[医药卫生—眼科] R722.1[医药卫生—临床医学]