硬膜外导管及针灸针直接插入吻合泪小管断裂

Anastomosing of fractured lacrimal canaliculi by the direct intubation with epidural catheter and acupuncture needle under the microscope

目的 探讨手术显微镜直视下用硬膜外导管套针灸针直接插入法吻合断裂泪小管的方法和经验.方法 急诊35例（35眼）泪小管断裂,在手术显微镜直视下寻找到泪小管鼻侧断端,将硬膜外导管剪成大约70～80 mm长,用钝头针灸针做管芯插入管内,再将其插入泪小管鼻侧断端,触及鼻侧骨壁后,顺鼻泪管向下进入下鼻道.退出针灸针,猪尾巴钩自下泪点将硬膜外导管从颢侧泪小管断端拉出,6-0可吸收缝线吻合断端管壁2针,将硬膜外导管固定于下睑皮肤.结果 35例中有33例成功吻合.术后3个月拔管,冲洗泪道通畅.术后6个月随诊,94%患者冲洗泪道保持通畅.结论 寻找泪小管鼻侧断端和准确将硬膜外导管置入下鼻道是手术的关键,手术显微镜直视下硬膜外导管套针炙针直接插入吻合法是一种简便、经济、有效的方法.

Objective To investigate the method and experience of the lacrimal canalicular anastomosis by the direct intubation with epidural catheter and acupuncture needle under the microscope. Methods It was retrospective case series study. 35 cases of the traumatic laceration of lacrimal canaliculus in the emergency department of Beijing Tongren Hospital were involved. As we worked to identify the proximal broken end of lacrimal canaliculus with the help of a microscope, we emplogyed acupuncture needles and epidural catheters as holdfasts and inserted them into the lacrimal canaliculus. Ultimately they were pushed further into the inferior canal of the nasal cavity. We ended up pulling out the epidural catheter through the lacrimal puncta with a pigtail probe,and the epidural catheter was sutured and fixed. Results The surgical alternative worked out well on 33 out of the 35 cases recorded. Of the 33 successful cases, the lacrimal canaliculus was found unbocked when the epidural catheter was pulled out 3 months later and remained unblocked for 94% of the cases in follow-up check-ups 6 months after the operation. Conclusion The key of the surgery is how to search rupturednasal canaliculus and insert the holdfast in the inferior nasal canal. Anastomosing of fractured lacrimalis canaliculi by direct intubation with epidural catheter and acupuncture needle under the microscope, offers a simple yet highly effective approach.