外路泪囊鼻腔吻合术失败原因与Nd:YAG激光再疏通治疗  

Unsuccessful external dacryocystorhinostomy(DCR): Causes and results of Nd:YAG laser revision

作　　者：路振莉[1] 蒋华[1] 王永强[1] 袁晔[1] 于立波[1] 

机构地区：[1]济南军区总医院眼科,山东济南250031

出　　处：《实用医药杂志》2014年第7期589-591,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的外路泪囊鼻腔吻合术(DCR)失败原因及Nd:YAG激光再疏通效果的认知存在争议,本文旨在探讨其失败背后的深层原因,并评估经泪小管Nd:YAG激光再疏通的效果。方法 20例外路DCR失败患者接受Nd:YAG激光泪道疏通,并通过回顾文献,与鼻窦内窥镜下修复及二次外路手术的效果进行了比较。结果 20例(21眼,共23次)外路DCR失败患者接受经泪小管Nd:YAG激光疏通治疗,其中仅3例探及造瘘口。具体的失败原因包括造瘘口缺如、膜性鼻泪管阻塞、骨性鼻泪管狭窄、泪小管阻塞、造瘘口瘢痕形成、造瘘口位置不当、丝线残留。成功率52.38%。平均随访时间85.7个月(7个月至12.8年)。结论透过具体原因发现,作为目前国内治疗鼻泪管阻塞最常用的手术方法,由非泪道专业医师完成本身成为外路DCR失败的重要原因。建议手术分级及准入体系应严格执行。而经泪小管Nd:YAG激光再疏通虽然部分有效,但成功率远低于鼻窦内窥镜下修复及二次外路手术。Objective Owing to opinions varied on reasons of unsuccessful dacryocystorhinostomy （DCR） and efficacy of Nd：YAG laser revision,hence to investigate deep reason for primary external DCR failure and to evaluate the effectiveness of transcanalicular Nd：YAG laser on revision. Methods The 20 patients after failed external DCR underwent Nd：YAG laser revision. Through review of literature above outcome was compared with the efficacy of endoscopy revision nasal sinuses and secondary external operation. Results The 20 patients （21 eyes） underwent 23 times of failed external DCR. Osteotomy was detected in only 3 cases. Concrete reasons included absence of rhinostomy,membraneous nasolacrimal duct （NLD） obstruction,NLD stenosis,canalicular obstruction,cicatrix at rhinostomy,misplaced osteotomy,retained silk thread. A success of 52.38% was achieved. Mean follow-up period was 85.7months （range from 7 to 154 months）. Conclusion As a main modality for NLD obstruction then in China,External DCR performed by non-lacrimal ophthalmologist might exert high risk of failure. Operation Grading and Entrance System should be implemented. Transcanalicular Nd：YAG laser revision is less successful than both endoscopic revision and repeat DCR.

关 键 词：外路泪囊鼻腔吻合术失败 ND YAG激光 修复 插管 手术分级及准入体系 

分 类 号：R779.6[医药卫生—眼科]