预置标记线在泪道内窥镜手术中的临床应用价值  

Clinical Application Value of a Preset Marking Line in LacrimalEndoscopic Surgery

作　　者：肖盼[1] 杨代慧[2] 黄正如[1] 邢茜[1] 陶建军[1] 孟逸芳[1] 李健[1] 陆炯[1] Pan Xiao;Daihui Yang;Zhengru Huang;Qian Xing;Jianjun Tao;Yifang Meng;Jian Li;Jiong Lu(Department of Ophthalmology,Changshu No.2 People's Hospital,Suzhou 215500,China;Department of Ophthalmology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]江苏省常熟市第二人民医院眼科,苏州215500 [2]南京医科大学第二附属医院眼科,210000

出　　处：《中华眼视光学与视觉科学杂志》2020年第1期64-68,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:探讨应用预置标记线在泪道内窥镜手术中的临床应用价值,评估其对手术并发症的影响。方法:前瞻性临床研究。选取2015年6月至2018年12月在常熟市第二人民医院眼科就诊的泪道阻塞患者60例(60眼)进行泪道内窥镜手术,按患者住院号的单双号分为2组,单号作为对照组术中不预置标记线,即传统方法治疗;双号作为观察组,即先预置标记线。观察并记录2组患者术中泪道黏膜损伤、出血、穿孔(假道)、眼睑水肿及术后出血等并发症的发生情况。采用χ2检验对数据进行分析。结果:观察组术中可清晰地观察预置标记线的数量,结合泪道解剖学特征来判断泪道内窥镜探头所处位置,如泪道内窥镜下显示1根标记线提示在泪小管内;显示2根标记线汇聚处提示在泪总管内;显示2根标记线并且操作空间增大提示在泪囊内;显示2根标记线,可见黏膜皱襞提示在鼻泪管内。观察组术中泪道黏膜损伤发生率(16%)、术中出血发生率(13%)和眼睑水肿发生率(10%)明显低于对照组(分别为52%、52%、35%),差异均有统计学意义(χ2=8.543,P=0.003;χ2=8.718,P=0.003;χ2=4.069,P=0.044);而术中穿孔(假道)对照组中发生了1例,组间差异无统计学意义(χ2=0.001,P=0.973)。术后组间出血发生率差异无统计学意义(χ2=1.898,P=0.168)。2组中所有患者术中、术后出血量均为少量,术中注水后不影响操作,术后少许出血者2 d内均能自行止血。结论:泪道内窥镜手术中应用预置标记线能更好地操控内窥镜检查及手术,能准确定位操作所处的位置,可减少并发症的发生。Objective:To explore the clinical application value of a preset marking line in lacrimal endoscopic surgery and evaluate its effect on surgical complications.Methods:This was a prospective analysis of clinical data from 60 patients(60 eyes)with lacrimal duct obstruction who had lacrimal endoscopic surgery in Changshu No.2 People's Hospital from June 2015 to December 2018.All patients were divided into two groups,a control group or observation group according to the even or odd numbers assigned to hospital patients.The control group(odd numbers)had no intra-surgery preset marking line.The observation group(even numbers)had an intra-surgery preset marking line.The complications of lacrimal duct mucosa injury,hemorrhage,perforation(false passage),eyelid edema and postoperative hemorrhage were observed and recorded.The data were analyzed by a Chi-square test.Results:In the observation group,the number of preset marking lines could be clearly observed during surgery,and combined with the position of the lacrimal endoscope,could be determined by the anatomical characteristics of the lacrimal passage.One marker line could be observed in the lacrimal canaliculi.The convergence of two marker lines could be observed in the common canaliculus.Two marker lines with an enlarged space could be observed in the lacrimal sac.Two marker lines with mucosal folds could be observed in the nasolacrimal duct.The incidence of lacrimal mucosal injury was 16%(χ2=8.543,P=0.003),hemorrhage incidence was 13%(χ2=8.718,P=0.003)and eyelid edema incidence was 10%(χ2=4.069,P=0.044)in the observation group,which were significantly lower than the incidences in the control group(52%,52%and 35%,respectively).One case of perforation(false passage)occurred in the control group,which was not statistically significant compared with the observation group(χ2=0.001,P=0.973).There was no statistically significant difference in the incidence of postoperative hemorrhage between the groups(χ2=1.898,P=0.168).Moreover,all patients in the two groups had a sma

关 键 词：泪道内窥镜 泪道置管术 预置标记线 泪道阻塞 

分 类 号：R47[医药卫生—护理学]