拔管时间对顺向泪道置管术疗效影响的对照研究  

Comparative trial on effect of silicone tube removal timing on the result of consequent lacrimal intubation

作　　者：陈光[1] 鲁静[1] 李丹[1] 彭新明[1] 赵越[1] 

机构地区：[1]河北大学附属医院眼科,保定071000

出　　处：《中国实用眼科杂志》2016年第6期576-579,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察并比较顺向泪道置管术后不同的拔管时间对于治疗泪道阻塞的疗效的影响。方法前瞻性随机单肓对照临床试验。对2011年6月至2014年5月在河北大学附属医院眼科连续纳入诊断为原发性泪道阻塞（包括上泪道阻塞和鼻泪管阻塞）的患者，进行泪道成形联合顺向泪道置管手术。将术后患者用数字法随机分配至两个组：A组术后1个月拔除泪道引流管，B组术后3个月拔除泪道引流管。拔管后6个月随访并统计手术成功率。结果最终完成随访的患者为248例（256只眼）。手术总有效率73．44％（188／256），A组和B组手术有效率分别为67．48％（83／123）、78．95％（105／133）（x^2=2．706，P=0．100）。上泪道阻塞的患者中，术后1个月与3个月拔管的手术有效率分别为64．44％（29／45）、87．76％（43／49），差异有统计学意义（x^2=7．110，P=0．008），鼻泪管阻塞的患者中，术后1个月与3个月拔管的手术有效率分别为69．23％（54／78）、73．81％（62／84），差异无统计学意义（x^20．417，P=0．518）。泪道炎症、拔管困难等并发症B组较A组更多见。结论顺向泪道置管手术是治疗泪道阻塞的安全、有效的术式。对于治疗上泪道阻塞而言，3个月拔管较1个月拔管手术有效率提高，对于治疗鼻泪管阻塞而言，不同的拔管时间对手术有效率无明显影响。长时间戴管可能带来更多的并发症。Objective To investigate and compare the clinical effectiveness of different silicone tube removal timing after consequent lacrimal intubation on the treatment of lacrimal duct obstruction. Methods In this retrospective, single-blind, randomized controlled, comparative clinical trial, the patients with lacrimal duct obstruction, including presaccal canalieular obstruction （PSCO） and nasolacrimal duct obstruction （NLDO）, were treated by lacrimal duct plasty combined with consequent lacrimal intubation. These patients were randomly divided into two groups by different timing of silicone tube removal： In Group A, silicone tube were removed at 1 month after surgery; In Group B, silicone tube were removed at 3 months after surgery. Effective rates were analyzed at 6 months after tube removal. Results A total of 248 patients （256 eyes） completed follow-up. The total effective rate reached 73.44% （188/256）, the effective rates of group A and group B were 67.48% （83/123）, 78.95% （105/133） respectively （x^2 =2.706, P =0.100）. The effective rates of PSCO in group A and group B were 64.44% （29/45）, 87.76% （43/49） respectively （x^2=7.110, P =0.008）, and the effective rates of NLDO in group A and group B were 69.23% （54/78）, 73.81% （62/84） respectively （x^2= 0.417, P =0.518）. Lacrimal duct inflammation, extubation difficulty were more seen in group B than in group A. Conclusions Consequent lacrimal intubation is an effective and nontraumatizing procedure for the treatment of lacrimal duct obstruction. For patients of PSCO, removal of the silicone tube at 3 months after surgery is more effective than at 1 month. But for patients of NLDO, different timing of silicone tube removal is less likely to affect the final result. Long-term wearing tube may bring more complications.

关 键 词：泪道阻塞 顺向泪道置管术 有效率 并发症 

分 类 号：R777.205[医药卫生—眼科]