应用改良Worst探针吻合泪小管断裂疗效分析  

Analysis on the efficiency and therapeutic effect of anastomosis for canalicular laceration by using modified worst probe

作　　者：梁涛[1] 赵桂秋[1] 孟旭霞[1] 杨珊珊[1] 吴媛[1] 李慧[1] 

机构地区：[1]青岛大学医学院附属医院眼科、眼科学国家重点学科,青岛266003

出　　处：《中国实用眼科杂志》2008年第12期1321-1324,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨应用改良Worst探针吻合泪小管断裂的效果。方法对87例泪小管断裂患者随机分为2组，A组41例、B组46例，分别采用传统Worst探针和改良Worst探针寻找泪小管鼻侧断端，行泪小管吻合术，留置直径0．95mm的PICC硅胶管4～6个月，拔管后随访3--6个月。结果B组采用改良Worst探针寻找泪小管鼻侧断端一次成功率为93．48％（43／46），总成功率为97．83％（45／46），所有患者术中均无假道形成，与A组相比，寻找泪小管断端一次成功率、术中假道形成率差异均具有统计学意义（P〈0．01和〈0．05），总成功率差异无统计学意义（P〉0．05）；寻找泪小管鼻侧断端时间平均为（5．02±2．73）min，手术平均耗时（33．90±4．84）min，与A组相比，差异具有显著统计学意义（P均〈0．01）；两组中各有1例患者泪总管缺如（2．30％）。B组治愈率95．65％，虽高于A组，但差异无显著统计学意义（P〉0．05）。结论改良Worst探针逆行插管法简便易行，是寻找泪小管断端的有效手段；对Worst探针进行合理的、必要的改良有利于降低手术并发症的发生率、提高泪小管断裂吻合手术的效率和成功率。Objective To investigate the necessity of modifying the traditional Worst probe and evaluate its efficiency and therapeutic effect on searching the nasal cut end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.Methods 87 patients （87 eyes）suffering from canalicular laceration were randomized into group A and B.During the reconstruction of the lacerated canaliculi,the traditional Worst probe and the modified Worst probe were used to seek for the nasal cut end of lacerated lacrimal canaliculi, respectively.PICC silicone tube with 0.95mm diameter was intubated as a stent for 4 to 6 months.Follow-up ranged from 3 to 6 months after stent removal.Results In group B using the modified Worst probe, the primary success rate of searching the nasal cut end of lacerated lacrimal canaliculi was 93.48% （43/46）and the final success rate was 97.83% （45/46）.No pseudo-passage was created in all 46 patients in group B.Compared with the primary success rate and pseudo-passage creating rate of Group A, statistical significances were found （P 〈0.01 and0.05）,whereas no significance was found between the two group as the final success rate was con- cemed （P 〉 0.05 ）.The mean time of searching the nasal cut end of lacerated lacrimal canaliculi was （5.02±2.73 ）minutes and the mean time of operation was（33.90±4.84）minutes,both were significant shorter than that of group A （P〈0.01）.The cure rate of group B was 95.65%,though higher than that of the group A,no statistical significance was found（P 〉 0.05 ）.Totally, 2 patients（2.30% ）were found absent of common canaliculus in the two group.Conclusion Worst probe is still an efficient and convenient apparatus for searching the nasal cut end of the lacerated lacrimal canaliculus in the reconstruction of canalicular laceration.Necessary or proper modifications to the Worst probe can minimize the risk of iatrogenic trauma or complication and enhance the efficiency of canalicular anastomosis operation.

关 键 词：泪小管断裂 插管 吻合术 泪道手术器械 

分 类 号：R777.22[医药卫生—眼科] R392-33[医药卫生—临床医学]