泪道激光联合Y型硅胶管逆行植入术治疗慢性泪囊炎和鼻泪管阻塞

Clinical observation of KTP laser combined with retrograde placement of Y - shaped silicone tube for the treatment of chronic dacryocystitis and nasolacrimal duct obstruction

目的观察泪道激光联合Y型硅胶管植入术治疗慢性泪囊炎和鼻泪管阻塞的效果。方法52例（59眼）。慢性泪囊炎41眼，鼻泪管阻塞18眼。先用KTP激光疏通泪道阻塞部位，然后将Y型硅胶管表面涂典必殊眼膏后从鼻腔逆行植入阻塞的泪道部位。术后用抗生素眼液定期冲洗泪道。结果全部一次成功植入Y型硅胶管，术中均未出现并发症。留置硅胶管3—8个月。5眼置管后出现鼻腔内分泌物增多，2眼分别在置管1个月和3个月时因打喷嚏导致硅胶管滑脱，所有患者均顺利拔管，拔管后随访6—12个月。治愈44眼（74．6％），好转11眼（18．6％）无效4眼（6．8％）。结论泪道激光联合Y型硅胶管逆行植入术治疗慢性泪囊炎和鼻泪管阻塞疗效良好。

Objective To evaluate the effect of KTP laser combined with retrograde placement of Y-shaped silicone tube for the treatment of chronic dacryocystitis and nasolacrimal duct obstruction. Meth- ods The surgery was performed in 52 cases（59 eyes）, among which 41 eyes with chronic dacryocystitis, 18 eyes with nasolacrimal duct obstruction. Firstly, the site of obstruction of lacrimal duct was dredged by u- sing KTP laser, afterwards Y-shaped silicone tubes coasted with eye ointment of TobraDex were inserted into the blocked lacrimal duct in retrograde mode. Postoperative irrigation with antibiotics eyedrops was done reg- ularly. Results The surgery was performed successfully in all cases. No intraoperative complications were found during the procedure. The silicone tubes were retained for 3 to 8 mouths, average （5.3 ± 2.1 ） months. The majority of the cases did not experience any untoward symptoms from these silicone tubes postoperative- ly. However, in 5 eyes there was the secretions in the nosal cavity. Additionally, in two eyes there was spontaneous extrusion of silicone tubes while sneezing 1 month and 3 months after surgery respectively. All the silicone tubes were removed smoothly. Mean follow-up time after tube removal was （ 8.9 ± 2.6 ） months （range 6 to 12 months ）. Complete resolution of symptoms was achieved in 74.6% （44 of 59） of the cases; a partial improvement of symptoms in 18.6% （11of59） ; and no improvement in 6.8% （4 of59）. Conclu- sion We can use KTP laser combined with retrograde placement of Y-shaped silicone tube to cure chronic dacryocystitis and nasolacrimal duct obstruction. The smgery, which is atraumatic, easy to perform, no scars, and better tolerated, may be popularized clinically.