年龄因素对儿童泪道插管手术治疗效果的影响  

Effect of age on surgical results in treatment of congenital nasolacrimal duct obstruction by Ritleng lacrimal intubation

作　　者：曹文红[1] 吴倩[1] 樊云葳[1] 王媛[1] 于刚[1] Cao Wenhong;Wu Qian;Fan Yunwei;Wang Yuan;Yu Gang(Department of Ophthalmology,Beijing Children＇s Hospital,Capital Medical University,National Center for Children＇s Health,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院眼科儿科学国家重点实验室国家儿童医学中心,100045

出　　处：《中国实用眼科杂志》2017年第9期869-873,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨年龄因素对Ritleng泪道插管治疗先天性泪道阻塞手术效果的影响。方法回顾性对照研究。收集2011年至2015年在北京儿童医院就诊并曾行泪道探通失败的先天性鼻泪道阻塞患儿175例287只眼，年龄范围6～72个月（平均22．5个月）。按年龄分为两组，≤24个月龄组121例214只眼，〉24个月龄组54例73只眼。所有患儿均于全麻下行Ritleng泪道插管术，治疗成功定义为泪道冲洗通畅；结膜囊无分泌物、无流泪等症状，荧光染料消失试验（FDDT试验）0级或1级。统计分析两组泪道探通次数和阻塞类型的差异，两组泪道插管手术治愈率、复发率的差异，以及两组拔管时间和术后并发症的差异。结果在≤24个月龄组，复杂性阻塞类型为22．0％（47／214）；在〉24个月龄组，复杂性阻塞类型为47。9％（35／73），二组差异均有统计学意义（P〈0．001）。治愈率≤24个月龄组为89-3％（191／214），〉24个月龄组为78．1％（57／73），两组差异有统计学意义（P=0．016）。复发率≤24个月龄组为1．6％（3／191），〉24个月龄组为8．8％（5／57），两组差异有统计学意义（P=0．007）。术后2个月拔管，≤24个月龄组为76．2％（163／214），〉24个月龄组为46．6％（34／73），两组差异有统计学意义（P=0．000）。并发症方面，≤24个月龄组硅胶管脱出和缝线脱落的发生率均显著高于〉24个月龄组（P〈0．05）；鼻翼肉芽肿形成与鼻腔出血的发生率则均显著低于〉24个月龄组（．P〈0．05）。结论2岁以上的先天性泪道阻塞患儿多数存在多次泪道探通失败的病史，复杂性泪道阻塞类型增多，行Ritleng泪道插管术治愈率显著下降，复发率升高，且术后拔管时间延长，鼻翼肉芽肿形成和术中术后鼻腔出血等并发症的风险增大。Objective To evaluate the effect of age on surgical results in treatment of congeni-tal nasolacrimal duct obstruction （CNLDO） by Ritleng lacrimal intubation. Methods Retrospective control study. The outcome of 287 eyes of silicone intubation with Ritleng lacrimal intubation sys-tem, performed on 175 children with CNLDO after failed probing （aged from 6 to 72 months with all average at 22.5 months）from Beijing Children＇s Hospital,Was retrospectively reviewed. The eyes were divided into 2 age categories：category 1（≤24 months,214 eyes） and category 2（〉24 months,73 eyes）. Treatment success was defined as absence of epiphora, mucous discharge or increased lacrimal lake after surgery.Number of probing, type of obstruction, the therapeutic rate and timing of tube-drawing of different age were analyzed. Complications were also compared. Results The rates of outcome above-mentioned between 2 groups respectively were： complex obstruction 22.0% （47/214）, 47.9%（35/73）; recovery rate 89.3%（191/214）,78.1%（57/73）; recurrence rate 1.6%（3/191）,8.8%（5/ 57）; tube-drawing in 2 months after surgery 76.2% （163/214）,46,6%（34/73）; significant differences were found between the groups. According to the complications, incidence rate of silicone intubation dropping and suture disconnection in group 1 were higher, instead, nose wing granuloma and nasal bleeding were less in group 1, both than that in group 2 significantly. Conclusions As the increase of the number of probing and the complex obstruction after the age of 2, the success rate of the op- eration decreased.

关 键 词：鼻泪管阻塞 插管手术 年龄 手术效果 

分 类 号：R777.230.5[医药卫生—眼科]