泪道内镜下环钻术治疗复发性上泪道阻塞的临床研究  

Cfinieal study on the treatment of relapse canalicular obstruction with trephination under lacrimal endoscopy

作　　者：杨代慧[1] 张晓俊[1] 柯秀峰[1] 李苏梅[1] 

机构地区：[1]南京医科大学第二附属医院眼科,210011

出　　处：《中华眼科杂志》2010年第2期166-170,共5页Chinese Journal of Ophthalmology

基　　金：江苏省高校自然科学基金资助项目（08KJD320003）

摘　　要：目的探讨在泪道内镜下行环钻术治疗复发性上泪道阻塞的方法及其临床疗效。方法回顾性系列病例研究。收集2007年2月至2008年2月南京医科大学第二附属医院眼科67例（73只眼）复发性上泪道阻塞患者的病历资料。患者局部麻醉后在泪道内镜下通过检查确定阻塞性质和部位，然后采用微型环钻清除泪道阻塞物并置入硅胶管治疗，拔管后随访6个月，观察疗效。结果术后3～5个月，73只眼均顺利拔管。其中51只眼（69．86％）治愈，即无流泪，泪道冲洗通畅；19只眼（26．03％）好转，即轻微流泪，泪道冲洗通，但不畅；3只眼（4．11％）无效，即仍流泪，泪道冲洗不通。有效率为95．89％（70／73）。且上下泪小管阻塞合并鼻泪管阻塞的有效率低于单纯下泪小管阻塞或泪总管阻塞。结论泪道内镜下环钻术是一种安全、有效的治疗复发性上泪道阻塞的手术，可明显提高治疗复发性上泪道阻塞的成功率。Objective To evaluate the efficacy of trephination under lacrimal endoscopy in the treatment of relapse canalicular obstruction. Methods In this retrospective cases series, 67 patients （73 eyes） with relapse canalicular obstruction were examined and treated in the Second Affiliated Hospital of Nanjing Medical University between Feb. 2007 and Feb. 2008. These patients were examined by endoscopy of the lacrimal drainage system under local anesthesia, the obstructions were treated with miniature annular drill and silicone stent intubation. All patients were followed up for 6 months postoperatively. Results Silicone tubes were successfully removed after 3 to 5 months postoperatively in all eyes. After followed up for 6 months, the complete successful rate, as defined on a total relief of epiphoria and patent on nasolacrimal irrigation,was 69. 86% （51/73）. Nineteen eyes （26. 03% ） showed improvement, which showed slight epiphoria and were unobstructed during irrigation of lacrimal passage. Three eyes （4. 11% ） were failure, which still had epiphoria and showed reflex during nasolacrimal irrigation. The effective rate of treatment was 95. 89% （70/73）. The effective rate for the treatment of upper and lower canalicular obstruction combined with nasolacrimal duct obstruction was lower than that of simple lower canalicular obstruction or common canalicular obstruction. Conclusions Trephination under lacrimal endoscopy is a nontranmatic and effective procedure for the treatment of relapse canalicular obstruction. It significantly improves the effective rate of treatment for eanalicular obstruction.

关 键 词：内窥镜检查 环钻术 泪器阻塞 复发 

分 类 号：R779.6[医药卫生—眼科]