外伤性泪道严重毁损患者48例临床回顾性研究  

Retrospective clinical study on 48 cases with severe traumatic lacrimal passage deformation

作　　者：陶海[1] 吴海洋[1] 侯世科[1] 王朋[1] 韩毳[1] 

机构地区：[1]武警总医院眼科泪器病中心,北京市100039

出　　处：《眼科新进展》2010年第1期53-55,58,共4页Recent Advances in Ophthalmology

基　　金：武警部队医学科研项目基金资助(编号:WJ200612)~~

摘　　要：目的探讨自体大隐静脉或口唇黏膜移植泪湖-鼻腔泪道再造手术治疗外伤性泪道严重毁损的实用性、有效性和安全性。方法回顾性分析48例(48眼)外伤性泪道严重毁损患者的致伤原因、伴随伤情况等。根据所采用4种手术方法将患者分成4组:A组患者5例5眼,患者行经鼻内窥镜入路的自体大隐静脉移植泪道再造术;B组患者6例6眼,患者行经鼻口口唇黏膜移植泪道再造术;C组患者17例17眼,患者行经皮肤入路的自体大隐静脉移植泪道再造术;D组患者20例20眼,患者行经皮肤入路的口唇黏膜移植泪道再造术。所造泪道均置入硅胶泪道支架管(直径为2.5mm),3个月后取出。拔管后随访3～10个月,平均5个月。对术后泪道通畅情况、泪溢症状改善的程度等做统计分析,对不同入路术式的优缺点进行分析和总结。结果48例(48眼)患者中,车祸伤28例,占58.33%,伴有眼睑和内眦部的外伤性畸形37例,占77.08%;4组患者术后带管3个月期间,泪溢症状即可得到不同程度的改善。拔管后1周,4组患者泪道均通畅,拔管后12周B组1例、C组2例、D组2例患者出现泪道阻塞。拔管后第12周,泪道行放射性核素99mm锝(TcO4-)显影检查,A、B、C、D4组核素入鼻时间分别为(8.4±5.2)min、(9.0±5.9)min、(6.6±5.2)min、(6.9±5.6)min,4组中时间最短是C组,时间最长是B组,差异有统计学意义(P<0.05)。A、B组治疗有效患者均为5例,C组和D组治疗有效患者分别为15例和18例。结论自体大隐静脉或口唇黏膜移植泪湖-鼻腔泪道再造手术治疗外伤性泪道严重毁损实用、安全、有效。Objective To investigate the feasihility,efficacy and safety of autogeneic great saphenous vein or labial mucosa transplantation and reconstruction of lacrimal lake-nasal lacrimal passage for patients with severe traumatic lacrimal passage deformation.Methods Retrospective analysis was taken on causes of injury,concomitant injury of 48 patients（48 eyes） with severe traumatic lacrimal passage deformation. According to the style of operation,patients were divided into 4 groups： patients were treated with reconstruction of lacrimal passage and autogeneic great saphenous vein transplantation via endoscopic transnasal dacryocystorhinostomy in group A（5 cases,5 eyes）,patients underwent construction of lacrimal passage and labial mucosa transplantation via endoscopic transnasal dacryocystorhinostomy in group B（6 cases,6 eyes）,patients underwent construction of lacrimal passage and autogeneic great saphenous vein transplantation via skin in group C（17 cases,17 eyes）,and patients underwent construction of lacrimal passage and labial mucosa transplantation via skin in group D（20 cases,20 eyes）.A silicone tube （diameter was 2.5 mm） was intubated into each reconstructed lacrimal passage,and removed 3 months later. The following up period was 3 months to 10 months （averaged in 5 months）. The drainability of reconstructed lacrimal passage and the alleveliation of epiphora were evaluated,the advantages and disadvantages of different operation were analyzed and summaried.Results In 48 patients （48 eyes） with severe traumatic lacrimal passage deformation,28 cases（58.33%） were injuried in traffic accident,37 cases（77.08%） were concomitanted with traumatic deformation of eyelids and inner canthus. Epiphora of patients in 4 groups were alleveliated in various degrees during the period with silicone tube at postoperative 3 months. The drainability of lacrimal passage was improved for patients in 4 groups at 1 week after removing the tube. There were 1 case in group B,1 case in group C and 2 c

关 键 词：泪道阻塞 泪道再造 隐静脉 口唇黏膜 移植 

分 类 号：R777.2[医药卫生—眼科]