先天性泪道瘘临床特征的初步研究  

A preliminary study on the clinical features of congenital lacrimal fistula

作　　者：徐毓 陶海[1] 王朋[1] 王菲[1] Xu Yu;Tao Hai;Wang Peng;Wang Fei(Lacrimal Disease Center of Ophthalmology,the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China;the Department of Ophthalmology,Tianjin Children’s Hospital,Tianjin 300074,China)

机构地区：[1]解放军总医院第三医学中心眼科泪器病中心,北京100039 [2]天津市儿童医院眼科,300074

出　　处：《中华眼科杂志》2020年第9期688-692,共5页Chinese Journal of Ophthalmology

基　　金：武警部队高层次人才培养项目(GCCRC-02)。

摘　　要：目的:总结先天性泪道瘘管临床特征。方法:回顾性系列病例研究。收集2011年7月至2017年11月解放军总医院第三医学中心眼科泪器病中心接诊的27例(32只眼)先天性泪道瘘患者的临床资料,分析患者性别、确诊年龄、患病眼别、家族史、全身情况,眼科检查指标(瘘口位置、瘘口外观、泪道冲洗情况、CT泪道造影三维重建和泪道内窥镜检查结果)以及治疗、随访情况。结果:27例先天性泪道瘘患者中,男女比例为1∶2。确诊年龄1~74岁,中位数为32岁。单眼瘘管与双眼瘘管比例为4.4∶1(22/5),单眼瘘管中左、右眼比例为1.2∶1(12/10)。27例就诊患者中22例为散发病例,5例为家族性发病病例。经家系图谱分析显示先天性泪道瘘呈常染色体显性遗传表现。27例32只眼有泪道瘘管,30只眼瘘管口位于内眦韧带下方泪囊区皮肤面,1只眼瘘管口位于泪阜部;1只眼瘘管口位于内眦部结膜面。32只眼均有溢泪表现,18只眼泪道冲洗可见冲洗液自瘘口流出,伴脓性分泌物流出。4例行泪道内窥镜检查发现泪道瘘管开口于泪总管同时发现泪道内有结石。27例患者中有8例采取随访观察;3例行治疗性泪道冲洗;16例接受瘘管切除术治疗,术后随访1~6年,全部治愈,无复发。结论:先天性泪道瘘以单眼多见,其开口多数位于内眦韧带下方泪囊区皮肤面,多数为散发病例,部分病例表现为家族遗传性,呈常染色体显性遗传。Objective To summarize the clinical characteristics of congenital lacrimal fistula for reference in its clinical diagnosis and treatment.Methods Retrospective case series study.The clinical data of 27 patients(32 eyes)with congenital lacrimal fistula admitted to the Lacrimal Center of Third Medical Center of PLA General Hospital from July 2011 to November 2017 were analyzed,including gender,age of diagnosis,left eye or right eye,family history,physical examination,ophthalmic examination,fistula opening location and appearance,symptoms,results of lacrimal duct irrigation,three-dimensional reconstruction of the lacrimal drainage system with CT,lacrimal endoscopy,treatment,outcomes and follow-up.Results In the 27 patients,the male to female ratio was 1∶2.The age of diagnosis was 1 to 74 years old,and the median was 32 years old.The ratio of unilateral fistula to bilateral fistula was 4.4∶1(22/5),and the ratio of left eyes to right eyes was 1.2∶1(12/10).The disease was sporadic in 22 patients,and 5 patients had a family history.Genetic analysis showed that congenital lacrimal fistula presented autosomal dominant inheritance.Fistulas were found on the skin surface of the lacrimal sac area under the medial canthus in 30 eyes,on the lacrimal caruncle in one eye,and on the conjunctiva of the medial canthus in one eye.All the patients presented with epihora,and irrigation liquid outflowed from the fistulas with purulence in 18 eyes.Lacrimal CT of the 27 patients showed contrast agents were left in the lacrimal sac.Lacrimal duct fistula was found open in the common canaliculus with concretions in the lacrimal system in four patients.Eight patients with mild symptoms underwent observation.Three patients underwent lacrimal therapeutic irrigation and probing.Sixteen patients underwent fistulectomy and were cured without recurrence during the follow-up of 1 to 6 years.Conclusions Congenital lacrimal fistula is usually unilateral,and the opening is mostly located on the skin surface of the lacrimal sac area under the inne

关 键 词：瘘 泪器 泪器疾病 系谱 

分 类 号：R777.2[医药卫生—眼科]