泪小管撕裂伤的临床特征及手术治疗

Clinical features and surgical treament of lacrimal canalicular laceration caused by temporal blepharal contusion

目的总结因颞侧眼睑挫伤牵拉间接引起泪小管断裂，表现为泪小管撕裂伤病例的临床特征、手术方法、治疗效果及并发症。方法回顾性分析温州医学院附属眼视光医院2004年1月到2010年1月诊治的颞侧皮肤挫伤致泪小管撕裂伤患者93例（93眼），对其致伤原因、损伤特点、泪小管鼻侧断端查找方法、手术方法、疗效及术后并发症进行总结分析。对数据进行分类计数，求百分比。结果93例患者泪小管撕裂均为车祸、拳击、坠地等钝挫伤从水平方向牵拉眼睑所致，其内眦部眼睑撕裂伤VI较长，创面组织结构紊乱，泪小管鼻侧断端常位于内眦角内后方深部组织内，并靠近泪总管，术中除2例因断端组织严重紊乱，放弃行泪小管吻合术外，其余91例经直视下或经泪总管均查找到鼻侧断端；89例行一期泪小管吻合术，2例陈旧性病例行二期泪小管泪囊吻合术。该91眼均放置泪道支撑管，于术后3-6个月拔除支撑管。拔管后随访病例85例，77例（91％）泪道通畅，6例（7％）狭窄，2例阻塞。少数病例出现支撑管脱落、泪点轻度外翻、泪小管裂开等并发症。结论泪小管撕裂伤为颞侧眼睑挫伤从水平方向牵拉致泪小管断裂的特殊类型，了解泪小管鼻侧断端靠近泪总管的临床特征，有利于术中查找。放置泪道支撑物的吻合术为有效的治疗泪小管撕裂伤的方法。

Objective To investigate the clinical features, treatment, therapeutic effect and complications of canalicular laceration indirectly caused by temporal blepharal contusion. Methods This study retrospectively analyzed 93 patients （93 eyes） with lacrimal canalicular laceration admitted to the Eye Hospital of Wenzhou Medical College from January 2004 to January 2010. Nosogenesis, features, methods for finding the nasal broken end of lacrimal canaliculus, treatment, therapeutic effect and postoperative complications of canalicular laceration indirectly caused by temporal blepharal contusion were summarized and analyzed, and described in percentages. Results Lacrimal canalicular laceration in all 93 eyes was caused by temporal blepharal contusion, such as a traffic accident, boxing or tumbling. The laceration in the eyelid of the inner canthus was very long, and the structure of the wound was not clean-cut. The nasal end of the broken lacrimal canaliculi was located in deeper tissue, close to the common canaliculus. All the paranasal broken ends were found directly or from the common lacrimal duct except for two patients whose treatments were terminated because of disorganized abrupt ends. Primary anastomosis of the lacrimal canal was performed on 89 patients, and secondary anastomosis of the canaliculus-to-lacrimal sac was performed on 2 patients. A support tube was implanted in each of 91 patients with canalicular laceration, then extubated 3 to 6 months after the operation. Follow-up observation of the 85 eyes showed complete patency in 77 patients （91%）, stenosis of the canaliculus in 6 patients （7%） and obstruent canaliculus was still present in 2 patients. A few cases presented with abscission of the support tube, ectropion of the lacrimal point, or dehiscence of the canaliculi. Conclusion As a special type of canalicular injury, indirect canalicular laceration is caused by temporal b｜epharal coutusion due to the horizontal tractive force action on the eyelid. Understanding the clinical features of the nasal end broken close to the common canaliculus helps in locating the abrupt ends. And anastomosis with a support tube is an effective treatment method.