泪点栓或泪小管栓置入后继发泪小管炎的临床诊治  

Preliminary report of clinical diagnosis and treatment of canaliculitis secondary to punctal plug or intracanalicular plug insertion

作　　者：白芳[1] 陶海[1] 

机构地区：[1]中国武警总医院眼科泪器病中心,北京市100039

出　　处：《眼科新进展》2014年第3期264-267,共4页Recent Advances in Ophthalmology

摘　　要：目的探索泪点栓和泪小管栓置入后继发泪小管炎的诊治方法及效果。方法回顾性分析置入泪点栓和泪小管栓后继发泪小管炎的4例(7眼8根泪小管)患者的临床资料,对其临床特点、检查方法、治疗方法及效果进行分析。结果 4例患者均为女性,8根泪小管中下泪小管有5根。置入泪道栓后继发泪小管炎的时间平均为36个月。8根泪小管的泪点及旁区均有不同程度红肿,均可见奶昔样黏脓性分泌物自泪点溢出。7眼患者尝味试验阳性率100%。泪道CT造影检查结果显示,7眼泪道(鼻泪管)通畅率100%,注入造影剂的7根泪小管中3根泪小管内可见中高密度影,泪小管显影率43%。6根泪小管行UBM检查结果显示,均可见形态特异的高回声影,阳性率100%。泪道内窥镜探查8根泪小管,异物发现率100%。其中2根泪小管最终给予泪道内窥镜下栓子冲洗排出术+人工泪小管置入术,2根泪小管给予泪道内窥镜下栓子冲洗排出术,另4根泪小管给予泪小管切开、栓子取出+人工泪小管置入术,泪小管切开率50%,泪道栓取出率100%。术前行UBM检查的6根泪小管,术中所见泪道栓子位置及形态与UBM检查一致率100%。2根泪小管中的2枚泪道栓位置与CT显影结果基本一致。结论泪道UBM检查能够较准确地显示泪道栓子在泪小管内存留的位置。采用泪小管切开、栓子取出并人工泪小管置入术治疗泪点栓或泪小管栓置入后继发泪小管炎均可获得良好效果。Objeetive To determine the diagnostic and treatment methods of canaliculitis secondary to punctal plug or intracanalicular plug insertion. Methods A retrospective analysis was conducted of the ocular examination and therapy of 4 pa- tients （ 7 eyes, 8 lacrimal canaliculus） who underwent secondary canaliculitis after punc- tal plug or intracanalicular plug insertion. Results Four patients were all female. There were 5 lower lacrimal canaliculus and 3 upper lacrimal canaliculi. Secondary canaliculitis were onset after insertions average 36 months. All of 8 puncta lacrimalia were red and edema, pouting with yellowish, mucopurulent discharge looked like milk shake. Seven canaliculus syringing were patency. One canaliculi wasn＇ t syringed be- cause of suffering acute imflamation. The positive rate of taste was 100%. CT dacryo- eystography suggested that patency rate of nasolacrimal duet was 100%. The abnormal high-density signals were seen in 3 canaliculus of 7 canaliculus injected contrast, the de- veloping rate of canaliculus was 43%. UBM were performed in 3 patients （6 canalicu- his）. The abnormal high intensity echo shadows were seen in all of 6 canaliculus. The positive rate was 100%. Eight canaliculus were searched using transcanalicular endoscopy, the rate of finding plug was 100%. Four canaliculus were performed irrigation via transcanalicular endoscopy and remov- el plugs away. Four canaliculus were performed canaliculotomy. Six canaliculus were intubated artificial silicone canalicu- lus. The rate of canaliculotomy was 50%. The rate of removel plug was 100%. The actual plugs location and shapes were the same as those of UBM examination in all 5 canaliculus. The actual plugs location and shape of 2 plugs in 2 canaliculus were consistented with the location of CT. Conclusion UBM is useful to locate the plugs in canaliculi before operation. Remo- ving plugs by lacrimal irrigation via transcanalicular endoscopy or by canaiiculotomy with canalicular intubation when remo- ving plugs by lacrimal irrigatio

关 键 词：泪点栓 泪小管栓 泪小管炎 超声生物显微镜 泪小管切开术 泪道内窥镜检查 

分 类 号：R777.22[医药卫生—眼科]