带套管泪道内镜逆行置管术治疗小泪囊鼻泪管阻塞临床观察  

Clinical observation of lacrimal stent retrograde intubation by sheath-guided dacryoendoscope in patients with nasolacrimal duct obstruction of small lacrimal sac

作　　者：侯泽江 陈楠[1] 杨卫华 蒋沁[1] 姚进[1] Hou Zejiang;Chen Nan;Yang Weihua;Jiang Qin;Yao Jin(Eye Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属眼科医院,210029

出　　处：《临床眼科杂志》2022年第5期446-449,共4页Journal of Clinical Ophthalmology

摘　　要：目的介绍一种带套管泪内镜逆行置管方法治疗小泪囊鼻泪管阻塞,观察和评估该术式的安全性和有效性。方法回顾性病例研究。22例(26只眼)小泪囊鼻泪管阻塞患者,采用泪道内镜逆行置管法治疗,通过直径为0.9 mm带套管的泪道内镜进行探查,鼻泪管轻度粘连直接探通,粘连较重者必要时更换1.1 mm直径镜头,采用环钻或激光将瘢痕组织去除,观察到鼻泪管黏膜,明确非假道后继续向下探通,直至达下鼻道,套管留置原位,利用记忆导丝逆行置管,置管3个月后取管,取管后随访3个月行泪道冲洗及了解有否溢泪等症状。结果所有病例均顺利探通至鼻泪管下端开口,无假道形成,成功置入人工泪管,其中3只眼鼻泪管瘢痕阻塞严重采用1.1 mm镜头使用环钻将瘢痕组织清除,5只眼术后1周泪道冲洗发现泪总管处有阻力,扩张泪总管,将人工鼻泪管向下牵拉后冲洗阻力减轻。取管后3个月复查结果:无溢泪、泪道冲洗通畅15只眼(57.7%);溢泪症状改善、泪道冲洗通而不畅6只眼(23.1%);溢泪症状无改善,泪道冲洗不通5只眼(19.2%),总有效率为80.8%。结论采用带套管泪道内镜对小泪囊鼻泪管阻塞患者进行逆行置管,手术操作精准,对泪道损伤小,探通成功率高,是治疗小泪囊鼻泪管阻塞理想的手术方式。Objective To introduce a retrograde intubation method by sheath-guided dacryoendoscope for treatment of nasolacrimal duct obstruction of small lacrimal sac,and to observe and evaluate the safety and effectiveness of this operation.Methods A prospective case series study.Patients with nasolacrimal duct obstruction of small lacrimal sac(22 cases,26 eyes)were treated with retrograde tube placement through sheath-guided dacryoendoscope.The sheath-guided dacryoendoscope with a lens diameter of 0.9 mm was used for exploration.The nasolacrimal duct with mild adhesion was directly probed,and the nasolacrimal duct with severe adhesion was probed with a lens diameter of 1.1 mm if necessary.A microdrill or laser was used in order to remove the scar tissue.The mucosa of the nasolacrimal duct was observed,which made it clear that it was not a false duct.Later,it continued to penetrate down until it reached inferior nasal meatus.The sheath was left in place,and the memory guide wire was used for retrograde tube placement.The tube was removed after 3 months.All patients were followed up for 3 months after the tube was removed.Lacrimal passage irrigation was performed,and symptoms such as epiphora were investigated during each follow-up visit.Results All cases were successfully probed to the end of the nasolacrimal duct without false duct formation,and silicone tubestents were successfully inserted.Among these cases,the nasolacrimal ducts in 3 eyes were severely blocked by scar tissue,and the scar tissue was removed through a dacryoendoscope with a 1.1 mm lens with a microdrill.Resistance at the total common canalicular to lacrimal duct irrigation in 5 eyes was found 1 week after surgery.In order to reduce the resistance,total common canaliculars were expanded and the spherical silicone tubes were pulled down little.Three months after tube extraction,15 eyes(57.7%)showed no epiphora or unobstructed lacrimal duct irrigation.6 eyes(23.1%)showed improved symptoms of lacrimal duct irrigation.5 eyes(19.2%)had no improvement in lacrim

关 键 词：泪道内镜 逆行置管术 小泪囊 鼻泪管阻塞 套管 

分 类 号：R779.6[医药卫生—眼科]