早期泪道探通术治疗先天性鼻泪管阻塞的疗效观察

Effect of early lacrimal passage probing on the treatment of congenital nasolacrimal duct obstruction

目的探讨先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNLDO)的最佳治疗时机,阻塞部位的不同对探通术成功率的影响,以及重复探通术的成功率。方法对804例(976只眼)1～48个月CNLDO患儿行表面麻醉下泪道探通术,按不同年龄组、不同阻塞部位和重复探通术的疗效进行回顾性分析。结果经过治疗治愈958只眼,总治愈率为98.2%。不同年龄组探通成功率差异有统计学意义(χ2=163.9,P<0.005),其中1～3个月婴儿的成功率为98.5%,高于其他年龄组。66只眼接受二、三次探通术,主要是鼻泪管多处阻塞者,占84.8%。一次探通的治愈率与二、三次探通的治愈率差异有统计学意义(χ2=186.0,P<0.005);二次探通与三次探通比较,差异无统计学意义(χ2=0.18,P>0.025)。结论 CNLDO患儿选择早期泪道探通的最佳治疗时机是1～3个月,鼻泪管多处阻塞患儿重复探通率高,2～3次探通不成功者应尽早采用其他方法进行治疗。

Objective To assess the effect, success rate and optimal timing of lacrimal passage probing for the treatment of congenital nasolacrimal duct obstruction （CNLDO）. Methods Data of eight hundred and four children patients （976 eyes） with congenital nasolacrimal duct obstruction aged from 1 to 48 months were studied. All cases were divided by age, the sites of obstruction in nasolacrimal duct and the time of probing. The repeated lacrimal passage probing was performed in these patients and the outcome of probing was evaluated. Results The overall success rate of probing was 98.2% （ 958 of 976 eyes ）. The differences in the success rate of first probing among different groups were signifi- cant （P 〈 0. 005 ）. The success rate of the group aged from 1 to 3 months was 98.5%, higher than those of another three groups. Sixty-Six eyes （84.8%） were treated with repeated probing caused by complicated obstruction in nasolacrimal duct. There was significant difference in the success rate between the first probing and the second probing（ X^2 = 186.0, P 〈 0.005 ）, while no significant difference in the success rate between the second probing and the third probing（ X^2 = 0. 18 ,P 〉 0. 025 ）. Conclusions The best timing for the first lacrimal passage probing in CNLDO was in age of 1 month to 3 months. The rate of repeat probing was higher in patients with complicated obstruction in nasolacrimal duct. Other therapeutic methods should be applied when the second or third probing was not successful.