新型泪道逆行置管术治疗鼻泪管阻塞

A novel retrograde intubation procedure for treatment of nasolacrimai duct obstruction

目的探讨新型泪道逆行置管术的临床效果及其特点等。方法选择在门诊治疗的鼻泪管阻塞及合并慢性泪囊炎患者，在局部麻醉下用泪道探通导引针将泪道引流管从鼻泪管下口置入泪道。术后治疗中观察引流管的位置、洁净度、溢泪及泪囊分泌物性状和被引流排出情况等，2～4周后拔管。按治疗后随诊时间的长短分组：（1）A组：统计1997年5月至2001年12月，深圳市中医院眼科治疗3年以上患者521例（613只眼），作为远期治疗效果观察组；（2）B组：统计2003年10月至2005年10月深圳市眼科医院治疗0．5至1．5年的381例患者（411只眼），及同期北京市顺义区医院眼科治疗的5例患者（6只眼），共386例患者（417只眼），作为近期治疗效果观察组。运用卡方检验对两组间治愈率进行比较。结果术后一般1周左右泪道冲洗通畅；2—3周溢泪症状消除；1～3周泪囊分泌物被引流排除干净，但个别患者黏液性分泌物持续3个月，予二次置管，二次置管治愈率为92．3％（23／26）。治愈率：A组为84．5％，B组为88．2％。两组治愈率比较，差异无统计学意义（P〉0．05）。手术、麻醉可导致短时间的患者复视和不适感，未见并发症。结论新型泪道逆行置管术，操作安全简便，基本无创伤，手术预后好，可作为治疗鼻泪管阻塞、慢性泪囊炎的方法。

Objective To investigate the effect of a novel intubation procedure for the treatment of nasolacrimal duct obstruction. Methods Nasolacrimal duct obstruction patients with chronic dacryocystitis were selected for undergoing the procedure of intubation in outpatient clinic. This procedure was performed under local anesthesia. Retrograde intubation was inserted into the nasolacrimal duct and guided with probing. The location of drainage tube, cleanliness, epiphora, secretion from lacrimal sac and other signs were observed 2-4 weeks after intubation. Patients were grouped according to postoperative follow-up time. Group A consisted 521 cases （613 eyes） who underwent operations from May 1997 to December 2001 in Shenzhen Ophthalmic Hospital and observed for 3-5 years to evaluate long-term results. Group B consisted 381 cases （411 eyes） who underwent operations from October 2003 to October 2005 in Shenzhen Ophthalmic Hospital and 5 cases （6 eyes） who underwent operations at the same time period in Beijing Shunyi District Hospital （ a total of 386 cases, 417 eyes） and observed for0.5-1.5 years as the recent treatment group. The cure rates of these two groups were compared using the chi-square test. Results The lacrimal system was able to be irrigated one week after the operation. Epiphora symptoms were eliminated 2-3 weeks postoperatively. Lacrimal sac secretions disappeared within 1-3 weeks in most cases, few patients still had mucous secretions after 3 weeks and needed the second intubation operation. The cure rate of second intubation was 92.3% （ 23/26 ）. The cure rates of Group A and Group B were 84.5% and 88.2%, respectively, There was no significant difference in cure rate between these two groups. Surgery and anesthesia could lead to a short period of diplopia and discomfort without any other complications. Conclusions The novel lacrimal retrograde tube and the operation procedure are safe, simple and without obvious trauma. The prognosis of the intubation operation is good and this method could be used as a treatment for nasolacrimal duct obstruction and chronic dacryocystitis.