新型泪道引流装置治疗泪道狭窄及泪小管断裂临床分析

The Clinical Application of New Nasal Lacrimal Drainadge Device in treatment of lacrimal obstruction and canaliccular laceration

目的设计泪道探通引流装置置入泪道,扩张泪道,缓解泪道狭窄,恢复泪液引流通路,消除眼表感染灶。方法设计新型泪道探通引流装置,由两端金属探子和中间的软性硅胶管组成。选择120例病人(女78例,男42例,80例慢性泪囊炎,20例泪小管断裂,20例泪小管狭窄)。1%氯麻液收敛鼻粘膜及眼表麻醉后,探通泪道,自上下泪小点插入泪道探通引流装置的探子至下鼻道前部鼻泪管开口处,用特制的鼻腔探子取出器钩出探子,硅胶管留置鼻腔内。术后每周冲洗泪道1次至1月,以后每月冲洗1次。3～6月取出引流管。泪小管断裂者插入探子后吻合泪小管。结果80例鼻泪管狭窄所致慢性泪囊炎患者流泪症状均在置管1周内消失,拔管1月后有18例慢性泪囊炎患者复发。20例泪小管断裂及20例泪小管狭窄患者术后流泪症状立即消失。拔管后观察3个月,无复发,泪道引流通畅。结论新型泪道探通引流装置治疗鼻泪管狭窄所致慢性泪囊炎、泪小管狭窄及泪小管断裂所致溢泪效果肯定,方法简单,组织创伤小,无局部及全身副作用,具有临床推广应用价值。

Objective To treat lacrimal obstration,repair canalicular laceration and recover lacrimal passage′s transportation,we design and perform a new probe-drain-lacrimal passage device for the patients with dacryocystitis and canalicular laceration.Methods The new device consists of two parts.Metallic probes are in the each end,the soft silicon tube is in between.120 patients (78 females,42 males,80 cases of chronic dacryocystitis,20 cases of canalicular laceration,20 cases of canalicular obstruction) were treated by probing of lacrimal duct,the probes of the devices were inserted into the lacrimal duct from superior and inferior punctum under a topic anesthesia,then extracting each end of the probe by endoscope in nasal cavity and retaining the silicon tube in the nasolacrimal canal.After the probing saline should be irrigated through the nasolacrimal duct into the nose.Postoperative antibiotic drops are used 4 times a day for few monthes.Irrigation of lacrimal duct was done twice in the first week after the surgery,then once a week to the first month.The device was extracted 3～6 months after the surgery.Results Lacrimation of 80 cases of chrocic dacryocystitis,20 cases of canalicular obstruction and 20 cases of canalicular laceration improved in the first week after the surgery.In the three months following up after extraction of the silicon tubes,nasolacrimal duct drained well in the most of the cases,but 16 cases of chronic dacryocystitis were recurred in one month after extraction.All these patients with canalicular laceration and a canalicular obstruction had the best results.Conclusions The new probe-drain-lacrimal duct device is very effective in treatment of chronic dacryocystitis,canalicular obstration and repiring canalicular laceration.There is no topical and general side effect.It has a widely value for clinical application.