陈旧性泪小管断裂阻塞段切除断端吻合联合硅胶管植入术的疗效分析  

End-end anastomosis combine with silicone tube implants for the treatmeat of obsolete lower canalicular laceration

作　　者：钱振彬 余波 涂云海 QIAN Zhenbin;YU Bo;TU Yunhai(Hangzhou District of the Eye Hospital,Wenzhou Medical University,Hangzhou 321000,China;Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院杭州院区,浙江杭州321000 [2]温州医科大学附属眼视光医院,浙江温州325027

出　　处：《中国实用眼科杂志》2018年第6期473-476,共4页Chinese Journal of Practical Ophthalmology

基　　金：温州市科技计划经费自筹项目(Y20160453)

摘　　要：目的观察阻塞段切除断端吻合联合硅胶管植入治疗陈旧性泪小管断裂的疗效。方法对21例(21只眼)陈旧性下泪小管断裂患者实施二期修复手术,术中在显微镜直视下或联合上泪点探针定位法找到泪小管的鼻侧断端,置入环形硅胶管,保留6个月。结果本组21例患者均成功找到泪小管鼻侧断端,整体治愈率71.4%,好转率14.3%,有效率85.7%,失败率14.3%。其中远端泪小管断裂距下泪小点>6 mm的手术治愈率58.3%,较近端泪小管阻塞部位≤6 mm的泪小管断裂手术治愈率88.9%低,但差异无统计学意义(P=0.178);远端泪小管断裂手术有效率75%,较近端泪小管断裂手术有效率100%低,但差异无统计学意义(P=0.229)。结论显微镜直视下或联合上泪点探针定位法行阻塞段切除断端吻合联合硅胶管植入治疗陈旧性泪小管断裂有效率高,并发症少,可作为陈旧性泪小管断裂的主要手术方式。陈旧性泪小管断裂的断裂部位可能对手术疗效产生影响。Objective To observe the efficacy of the blocking off segment resection and two ends anastomosis combine with silicone tube implants under upper canalicular probing in locating the medial cut end of lower canalicular laceration for the treatmeat of obsolete canalicular laceration.Methods 21 patients(21 eyes)with obsolete lower lacrimal canalicular laceration underwent second stage repair surgery.The end of the nasal lacrimal canaliculus was found under the microscope or combined with the upper canalicular probing in locating during the operation,silicone tube was implanted and retained for 6 months.The lacrimal canalicular laceration was defined as distal canalicular laceration when the distance of obstruction site from the inferior puncta>6 mm.The lacrimal canalicular laceration was defined as proximal canalicular laceration when the distance of obstruction site from the inferior puncta≤6 mm.Results All the 21 patients successfully found the end of the nasal segment of canalicular laceration.The overall cure rate was 71.4%,the improvement rate was 14.3%,the effective rate was 85.7%,and the failure rate was 14.3%.Both the cure rate and effective rate of distal canaliculus laceration were lower than that in proximal canaliculus laceration group,but there were no statistical significances(P>0.05).Conclusions The blocking off segment resection and end-end anastomosis combine with silicone tube implants for the treatmeat of obsolete canalicular laceration has the advantages of high efficiency,less complications.It can be used as the main surgical methods in restore obsolete canalicular laceration.The obstruction site of the obsolete canalicular laceration may have an effect on the surgical outcome.

关 键 词：陈旧性泪小管断裂 上泪点探针定位法 硅胶管置入 

分 类 号：R77[医药卫生—眼科]