先天性鼻泪管阻塞探通治疗时机的探讨  

Management timing of congenital nasolacrimal duct obstruction

作　　者：王永成[1] 朱大强[1] WANG Yong-cheng;ZHU Da-qiang(Ophthalmology,the second affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院眼科,郑州450000

出　　处：《医药论坛杂志》2019年第12期40-43,共4页Journal of Medical Forum

摘　　要：目的探讨不同首诊年龄的先天性鼻泪管阻塞患儿行泪道探通术的最佳时机。方法回顾性分析来郑州大学第二附属医院就诊的不同首诊年龄的先天性鼻泪管阻塞患儿治疗情况,共106例128眼,首诊年龄1~16个月,月龄小于2个月患儿予以泪囊区按摩联合妥布霉素滴眼液点眼保守治疗,2-4周后无效者即行泪道冲洗联合泪道探通。3个月以上患儿行泪道探通术治疗,119眼行泪道探通,117眼痊愈,占9&32%(其中24眼经二次探通痊愈),9例9眼行保守治疗,2例失访。按月龄患儿分为A组(3~6个月),B组(7~12个月),C组(13~16个月),2例失访。术后疗效判断标准如下:治愈:溢泪症状完全消失,按压泪囊区无粘液或脓液溢出。无效:症状无改善,泪道冲洗不通畅。应用SPSS20.0对数据进行统计学分析。结果保守治疗9例9眼均痊愈,占7.03%。119眼行泪道探通,117眼痊愈,占9&32%(其中24眼经二次探通痊愈),一次性探通总有效率79.49%,无并发症发生。首诊年龄3~6月,7~12个月,13-16个月龄患儿一次性探通成功率分别为91.84%,72.22%,64.29%,其中3~6月龄患儿一次性泪道探通成功率最高。三组差异具有统计学意义(χ^2=8.829,χ^2=0.009),A组分别与B组和C组对比差异有统计学意义(χ^2=6.570,P=0.012;χ^2=4.688,P=0.02),B月与C组对比差别没有统计学意义(χ^2=0.063,P=0.743)。结论泪道探通术治疗先天性泪道阻塞成功率高,且无明显的手术并发症,一次泪道探通的治愈率随患儿年龄增长呈下降趋势,在保守治疗无效的情况下3~6月是先天性鼻泪管阻塞探通治疗的最佳时机。Objective To explore the best time of probing for congenital nasolacrimal duct obstruction.Methods A retrospective analysis,106 cases(128 eyes)of congenital nasolacrimal duct obstruction were treated in our hospital.The age of the first visit is 1 to 16 months.The children aged less than 2 months were treated with lacrimal sac massage combined with tobramycin eye drops,and those who were ineffective after 2 weeks were treated with syphilis of lacrimal passages combined with lacrimal passage probing.The children were treated with lacrimal duct probing for more than 3 months,119 eyes were treated with lacrimal duct probing,117 eyes were cured,accounting for 98.32%(24 eyes were cured by secondary probing),9 eyes were treated conservatively and 2 cases were lost.According to the age,the children were divided into group A(3~6 months),B group(7~12 months),C group(13~16 months),9 cases(9 eyes)received conservative treatment,2 cases lost follow-up.The criteria for judging the curative effect after operation are as follows:Cure:the symptoms of lacrimal overflow disappeared completely,and there was no mucus or pus overflow in the lacrimal bursa area.Invalid:symptoms did not improve,lacrimal passage washing was not smooth.SPSS20.0 was used to analyze the data statistically.Results 9 eyes of 9 cases(7.03%)were cured in conservative treatment.119 eyes were treated with probing of lacrimal passage,117 eyes(9&32%)were cured(24 eyes were cured by secondary probing),The total cure rate was 79.49%.No complications occurred.The success rates of one-time lacrimal passage probing in children aged 3〜6 months,7~12 months and 13~16 months were 41.84%,72.22%and 64.29%respectively.The success rate of lacrimal passage probing in children aged 3~6 months was the highest.The differences among the three groups were statistically significant(χ^2=8.829,P=0.009).There was significant difference between group A and group B and group C,respectively.(χ^2=6.570,P=0.012;χ^2=4.688,P=0.02).There was no significant difference between group B and gr

关 键 词：鼻泪管阻塞 探通 先天性 

分 类 号：R446.11[医药卫生—诊断学]