泪囊鼻腔吻合加泪小管置管治疗创伤性泪道损伤  

Treatment of traumatic lacrimal duct damage with dacryocystorhinostomy and canalicular intubation

作　　者：陈舒 蔡小剑[1] 黄东辉[1] 陈学华 CHEN Shu;CAI Xiaojian;HUANG Donghui;CHEN Xuehua(Otolaryngology Department,Foshan Hospital of Traditional Chinese Medicine,Guangdong,Foshan 528000,China;Otolaryngology Department,the First People’s Hospital of Foshan,Guangdong,Foshan 528000,China)

机构地区：[1]广东省佛山市中医院耳鼻喉科,广东佛山528000 [2]广东省佛山市第一人民医院耳鼻喉科,广东佛山528000

出　　处：《中国医药科学》2023年第20期163-166,191,共5页China Medicine And Pharmacy

基　　金：广东省佛山市科技创新项目自筹经费类科技计划项目(2020001005739)。

摘　　要：目的探讨泪囊鼻腔开放加泪小管置管对创伤性泪道损伤的治疗作用。方法选择2010年2月至2020年10月在佛山市中医院手术的62例面中部骨折合并泪道损伤患者进行分析、回顾,病程超过4周的患者的治疗过程,所有患者均行泪道造影,28例患者行下鼻道逆行鼻泪管义置管术,34例患者行鼻内镜下经鼻泪囊鼻腔吻合+泪小管置管术,术后随诊18个月以上,观察术后疗效。结果经下鼻道鼻泪管义管置管组,治愈12例,有效8例,无效8例,有效率为71.43%(20/28);鼻内镜下经鼻泪囊鼻腔吻合+泪小管置管组,治愈23例,有效9例,无效2例,有效率为94.12%(32/34),泪囊鼻腔吻合+泪小管置管组高于鼻泪管义管置管组,差异有统计学意义(P<0.05)。其中有15例患者因泪囊鼻泪管受压无法行经下鼻道鼻泪管义管置管,只能内镜下经鼻去除骨折片行泪囊鼻腔吻合术(加置管)。结论经下鼻道鼻泪管义管植入,手术简单,耗时较少,对于病程超过4周的创伤性泪道损伤患者,仍然具有一定的治疗作用,但有时骨折移位时无法成功经下鼻道植入义管,经鼻泪囊鼻腔吻合+泪小管置管的有效率更高,值得临床推广使用。Objective To explore the therapeutic effect of dacryocystorhinostomy and canalicular intubation on traumatic lacrimal duct damage.Methods A total of 62 patients with midface fracture and lacrimal duct damage who received surgeries at Foshan Hospital of Traditional Chinese Medicine from February 2010 to October 2020 were analyzed and reviewed.In the treatment process of patients with a course of more than 4 weeks,all patients underwent radiography of the lacrimal duct,28 patients underwent reverse silicone tube intubation of the nasolacrimal duct in the inferior nasal meatus,and 34 patients underwent endonasal endoscopic dacryocystorhinostomy+canalicular intubation.Postoperative follow-up was conducted for more than 18 months to observe the postoperative efficacy.Results In the group under silicone tube intubation of nasolacrimal duct through the inferior nasal meatus,12 cases were completely cured,8 cases were improved,8 cases were ineffective,and the effective rate was 71.43%(20/28);In the group under endonasal endoscopic dacryocystorhinostomy+canalicular intubation,23 cases were completely cured,9 cases were improved,and 2 cases were ineffective.The effective rate was 94.12%(32/34).The effective rate of the group of dacryocystorhinostomy and canalicular intubation was higher than that of the group of silicone tube intubation of the nasolacrimal duct,with a statistically significant difference(P<0.05).15 patients were unable to receive the silicone tube intubation of the nasolacrimal duct through the inferior nasal meatus due to the pressure of the lacrimal sac nasolacrimal duct,and could only receive dacryocystorhinostomy(plus intubation)by removing the fracture fragments through the nose under endoscope.Conclusion Implantation of the silicone tube of the nasolacrimal duct through the inferior nasal meatus is simple and time-consuming.It still has a certain therapeutic effect on patients with traumatic lacrimal duct damage whose course of disease exceeds 4 weeks.However,sometimes when the fracture is displaced,

关 键 词：泪道损伤 鼻泪管置管 泪小管置管 泪囊鼻腔吻合术 

分 类 号：R777.23[医药卫生—眼科]