上泪点泪道探针法在合并内眦韧带断裂下泪小管断端定位中应用  

Upper canalicular probing in locating the medial cut end of lower canalicular laceration with medial canthal ligament avulsion

作　　者：陈犇[1] 涂云海[1] 施节亮[1] 余波[1] 吴文灿[1] 

机构地区：[1]温州医科大学附属眼视光医院,温州市325027

出　　处：《中国实用眼科杂志》2016年第9期985-988,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨上泪点泪道探针法定位合并内眦韧带断裂的下泪小管断端的可行性。方法采用病例对照方法。于2014年3月至2015年2月在温州医科大学附属眼视光医院收集56例（男42例，女14例）合并内眦韧带断裂的下泪小管断裂患者，行下泪小管断裂吻合并置管术。应数字随机法随机分成2组，术中分别以上泪点置泪道探针定位下泪小管鼻侧断端（A组，n=30），或直接寻找断端（B组，n=26）。定位断端后以线型人工泪管环形置管支撑泪道。人工泪管留置3个月后拔管，术后随访时间6～12个月，分析比较2组下泪小管断裂的位置，探查时间，手术成功率，并发症等。结果56例患者术中均找到下泪小管鼻侧断端并成功吻合。其中A组28例治愈（患者无溢泪，泪道冲洗通畅）；1例好转（患者偶有溢泪，泪道冲洗通畅）；1例失败（患者溢泪，泪道冲洗自原泪点返流）；B组24例治愈，1例好转，1例失败。A组下泪小管断裂处与下泪小点距离为（8．0±0．6）mm，与B组（7．9±0．6）mm差异无统计学意义（P=0．66），A组探查定位下泪小管断端的时间为（90±41）s，显著小于B组，差异有统计学意义（202±78）s（P〈0．05），A组1例下睑近内眦部轻度外翻，无内眦畸形等并发症。结论合并内眦韧带断裂的下泪小管断端往往难以探查定位。应用上泪小点探针法有助于定位鼻侧断端，操作简单，可缩短手术时间，值得推广．Objective To investigate the suitability of upper canalicular probing in locating the medial cut end of lower canalicular laceration with medial canthal ligament eculsion. Methods A case-control study. Fifty-six patients （42 males, 14 females） with lower canalicular and medial .canthal ligament lacerations were randomly and equally divided into 2 groups. All patients underwent canalicular lacerations repair with bicanalicular silicone intubation. Upper canalicular probing was introduced in group A （n=30） for locating the medial cut end of lower canalicular lacerations, and direct searching were performed in group B （n=26）. In both groups, the silicone tubes were kept in the lacrimal passage for 3 months. Postoperative follow up ranged from 6-12 months. Outcomes were compared between 2 groups, considering the location of canalicular laceration, time for locating the medial cut end, success rate of free lacrimal passage repair, and complications. Results The 56 patients with lower canaliular lacerations were repaired successfully. The total free lacrimal passage reconstruction was achieved in 52 patients （28/30 in group A, 24/26 in group B）. There was no significant difference in the 2 groups （8.0±0.6mm in group A, 7.9±0.6mm in group B） in the distance between the lower punctum and the lateral cut end of canalicular laceration. Time for locating the medial cut end was significantly shorter in group A （90±41s） than in group B （202±78s）. One patient had slight ectropion in group A. There was no inner canthus deformity or other complications in both groups. Conclusions The upper canalicular probing technique can help to reduce the time of locating the medial cut end of lower canalicular laceration with medial canthus ligament evulsion.

关 键 词：下泪小管断裂 泪道探针 内眦韧带断裂 

分 类 号：R779.6[医药卫生—眼科]