泪道内镜下治疗泪道阻塞性疾病的初步观察

Observation on treatment of lacrimal passage obstruction under lacrimal endoscope

目的探讨泪道内窥镜对泪道阻塞性疾病的治疗效果，并比较泪道激光和微型电钻对阻塞部位的探通治愈率和并发症发生率。方法前瞻性随机对照临床试验。2006年9至12月在华中科技大学同济医学院附属协和医院眼科对89例（104只眼）上泪道阻塞（包括泪小管阻塞、泪总管阻塞）（PSCO）与鼻泪管阻塞（NLDO）的患者于局部麻醉下使用泪道内镜进行泪道检查，了解泪道黏膜和阻塞情况，针对阻塞部位进行激光或微型电钻处理，泪道冲洗通畅后，注入0．3％妥布霉素＋0．1％地塞米松眼膏。术后随访9～12个月，观察疗效与并发症，比较激光与微型电钻对不同阻塞部位治疗的效果和应用特点。疗效与并发症分析采用Χ^2检验。结果89例患者的泪道阻塞状况和部位均能被有效观察。术中泪道阻塞再通率为100．00％（104／104），术后随访治愈率78．85％（82／104）。PSCO和NLDO治愈率分别为77．78％（42／54）、80．00％（40／50）（Χ^2=0．077，P=0．782）。激光和微型电钻治愈率分别为80．43％（37／46）、77．59％（45／58）（Χ^2=0．125，P=0．724）。泪道激光治疗PSCO、NLDO治愈率分别为89．66％（26／29）、64．71％（11／17）（Χ^2=4．239，P=0．040），微型电钻治疗PSCO、NLDO治愈率分别为64．00％（16／25）、87．88％（29／33）（Χ^2=4．664，P=0．031）。激光治疗组和微型电钻治疗组术中出血发生率分别为10．87％（5／46）、55．17％（32／58）（Χ^2=21．969，P=0．000），激光治疗组和微型电钻治疗组术中眼睑水肿发生率分别为4．35％（2／46）、6．90％（4／58）（Χ^2=0．017，P=0．896）。结论泪道内镜能在直视下对泪道阻塞性疾病进行精确观察和针对性治疗。针对不同阻塞部位选择不同治疗方法将有助于提高患者手术效果。

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients （104 eyes ） with lacrimal passage obstruction, including presaccal canalicular obstruction （PSCO） and nasolacrimal duct obstruction （NLDO）, were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0. 3% tobramycin and 0. 1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions （104/104 eyes） were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% （82/104 eyes）. The cure rate of PSCO group and NLDO group, reached 77. 78% （42/54 eyes） and 80. 00% （40/50 eyes）, respectively （Χ^2 = 0. 077,P =0. 782）. The cure rate of laser group and micro-drill group, was 80. 43% （37/46 eyes） and 77.59% （45/58 eyes） , respectively （ Χ^2 = 0. 125, P = 0. 724 ） . The cure rate of laser treatment was 89. 66% （26/29 eyes） in the PSCO group and 64. 71% （ 11/17 eyes） in the NLDO group （P =0. 040）. The cure rate of micro-drill treatment was 64. 00% （ 16/25 eyes） in the PSCO group and 87. 88% （ 29/33 eyes） in the NLDO group （Χ^2 =4. 664,P =0. 031 ）. Hemorrhage and palpebral edema occured in 10. 87% （5/46 eyes） and 4. 35% （2/46 eyes） after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% （32/58 eyes ） （compared to the laser group, Χ^2 =21. 969,P =0. 000） and 6. 90% （4/58 eyes） （compared to the laser group, Χ^2 =0. 017 ,P =0. 896）. Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.