“经皮肤一针吻合法”修复泪小管断裂的临床研究

Clinical study on "one-stitch" repair of canalicular laceration

目的探讨“经皮肤一针吻合法”修复泪小管断裂手术的安全性和有效性。方法回顾性分析32例（32眼）采用“经皮肤一针吻合法”修复的泪小管断裂。下泪小管断裂29例，上泪小管断裂1例，上下泪小管同时断裂2例。手术均在手术显微镜下进行，用5-0丝线缝合，用硬膜外麻醉导管（直径0．8mm）作为泪管支架，术后3个月拔除硬膜外麻醉导管支架。结果32例中，治愈28例（87．50％），基本治愈3例（9．38％），无效1例（3．12％）。拔除支架管后，29例随访1—36个月（平均12个月），3例失随访。所有病例眼睑伤口愈合良好。无眼睑和内眦外伤性畸形。结论“经皮肤一针吻合法”修复泪小管断裂，能直接吻合泪小管的两断段，伤口不长期存留缝线，避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。

Objective To evaluate the efficacy and safety of ＂one-stitch anastomosis through the skin＂ repair of canalicular laceration. Methods The charts of 32 cases （32 eyes） of canalicular laceration who underwent repair of lacerated canaliculi with onestitch anastomosis through the skin were retrospectively reviewed, inferior canalicular laceration in 8 patients, superior canalicular laceration in 1 patient, 1 case involving both the inferior and superior analicular laceration. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with epidural tube （diameter is 0.8 mm） intubation. The stents were left in place for 3 months postoperatively and then removed. The follow- up period was 1 to 36 months. Results In 32 patients, 28 （ 87.50% ） patients were cured entirely, 3 （9.38%） patients were meliorated, 1 （3.12%） patient with no effects. 29 patients complied with scheduled follow up 3- 36 months （average 12 months） after stent removal, 3 patients were lost to follow up. All the patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Conclusions In ＂ one - stitch anastomosis through the skin＂ repair of canalicular laceration, the cut ends could be anastomosed directly, for there were on suture remained in the wound permenently, so there was no suture - related granuloma which might cause obstruction or stenosis of canaliculi. It was simple, economical, effective and safe.