同期手术治疗外伤性泪囊炎合并内眦畸形的临床观察

Clinical observation of surgical treatment of traumatic dacryocystitis and inner canthal deformity in one stage

目的探讨外伤所致泪囊炎合并内眦畸形的同期手术方法及其疗效。方法回顾分析17例单侧外伤性泪囊炎合并内眦移位患者临床资料。患者均行鼻腔泪囊吻合术联合内眦韧带钻孔固定内眦成形术,术中参照对侧内眦位置,在其前下方开凿骨窗行鼻腔泪囊吻合,在骨窗上方相应内眦点位置的骨壁上钻孔固定内眦韧带残端。术后随访6个月评估疗效。结果 17例患者术后患侧内眦点位置与健侧基本对称,泪道冲洗通畅。随访6个月,除2例患者内眦位置有轻度回退,其余形态良好,内眦畸形矫正率为88.2%;患侧泪道均未发生再次阻塞,泪囊炎治愈率为100%。结论对于外伤性泪囊炎合并内眦畸形患者主张同期行鼻腔泪囊吻合和内眦韧带钻孔固定内眦成形术,效果显著且疗效稳定,有利于功能与形态的同期恢复。

Objective To investigate the surgical methods and effectiveness of treatment of traumatic dacryocystitis and inner canthal deformity in one stage. Methods The clinical data of 17 patients with unilateral traumatic dacryocystitis and inner canthal displacement were retrospectively analysed.All patients underwent dacryocystorhinostomy combined with inner canthoplasty by inner canthal ligament fixation.During the dacryocystorhinostomy,a bone window was cut under the new inner canthus according to the position of contralateral inner canthus.A hole was drilled above the bone window,which was used to fix the inner canthal ligament.All patients were followed up for 6 months,and the therapeutic effect was evaluated.Results Favorable outcomes were achieved in all the 17 patients after surgery.The position of inner canthus of the injury side was symmetrical to the normal side,and the lacrimal ducts were unobstructed.Six months after operation,slight retreat of the inner canthus occurred in 2 patients,and the appearance of the other patients was fine,with the recovery rate of inner canthal deformity of 88.2%.No recurrence of lacrimal duct obstruction was found during follow up,and the recovery rate of dacryocystitis was 100%. Conclusion Dacryocystorhinostomy combined with inner canthoplasty by canthal ligament fixation are effective to patients with traumatic dacryocystitis and inner canthal deformity,which can lead to favorable and stable results.