正常兔眼泪囊急速萎缩的实验研究

Experimental study on rapid atrophy of lacrimal sac in normal rabbit eyes

目的探索一种治疗泪囊炎快速微创方法的实验研究。方法选择新西兰大白兔7只(14眼),随机分成对照组1只(2眼)、平阳组(6只左眼)、磷霉素葡萄糖组(6只右眼)。对白兔泪道按照泪道冲洗操作规范注药。对照组:9g·L-1生理盐水。平阳组:盐酸平阳霉素1mg·kg-1、地塞米松10mg、2g·L-1利多卡因2mL、2mL生理盐水充分混匀。磷霉素葡萄糖组:磷霉素钠粉剂2g与2.78mol·L-1葡萄糖20mL充分混匀,用5mL注射器抽取4mL备用。在给药后1周、2周两个不同时间段解剖分离出泪囊并观察其组织病理形态学变化。结果对照组无明显变化,泪道黏膜为柱状上皮,结构基本正常。给药后1周,平阳组泪道冲洗通畅,泪道黏膜上皮细胞水肿,上皮下少量炎细胞浸润;磷霉素葡萄糖组泪道冲洗不通畅,黏膜上皮水肿,上皮下大量炎细胞浸润;给药后2周,平阳组泪道冲洗通畅,泪道黏膜上皮细胞增生结构紊乱,少量上皮细胞内陷入软组织中,上皮下炎细胞浸润;磷霉素葡萄糖组泪囊组织炎性细胞浸润,黏膜上皮细胞大部分缺失,泪囊腔内可见血液和胶原渗出,泪囊腔狭窄,泪囊明显萎缩,与周围组织未见明显粘连。结论磷霉素钠葡萄糖泪道注射硬化剂疗法对兔泪道有较好的闭塞作用,2周即可导致泪囊萎缩,效果优于平阳霉素。临床上尤其适用于合并全身并发症无法实施或不愿意手术的老年慢性泪囊炎患者,有着重要的临床应用价值。

Objeetive To explore the experimental study for a rapid,radical and minimally invasive method for dacryocystitis. Methodg Seven New Zealand rabbits （ 14 eyes） were randomly divided into control group （ 1 rabbit,2 eyes） ,Pingyang group （ 6 left eyes） and fosfomycin sodium glucose group （ 6 right eyes）. The different harden- ers were injected into rabbit lacrimal duct：The control group was injected with normal sodium （9 g ·L^-1） ; The Pingyang group with bleomycin （ 1 mg·L^-1）, dexamethasone （10 rag）,lidocaine （2 g ·L^-1 ,2 mL） and normal sodium （2 mL）; Fosfomycin sodium glucose group with fosfomycin sodium powder （2 g） and glucose （2.78 tool·L^-1, 20 mL）. The lacrimal sac was extracted, and the pathological changes at 1 week and 2 weeks after injection were observed, lge No significant change appeared in the control group, the mucosa was columnar epithelium, the basic structure of the lacrimal mucosa was normal. At 1 week week after injection, the lacrimal duct was unobstructed inPingyang group, the mucosa epithelium was edema, the infiltration of inflammatory cells in sub-epithelium was seen; The lacrimal duct was obstructed in fosfomycin sodium glu- cose group,the mueosa epithelium was edema,many infiltration of inflammatory cells in sub-epithelium was seen. At 2 weeks after injection, the lacrimal duct was unobstructed in Pingyang group, the mucosa epithelial cells proliferated with irregular structure, few epithelial cells were immersed in soft tissue, the infiltration of inflammatory cells in sub- epithelium was seen;The infiltration of inflammatory cells in lacrimal sac was seen,the mucosa epithelium was mostly lost, some blood and collagen were exudated, lacrimal sac was obstructed with obvious atrophy ,no obvious adhesion with the surrounding tis- sue was seen. Corlusion Fosfomycin sodium glucose sclerotherapy for rabbit lacri- mal duct has better blockineffectinio.ction of ：lsac,and the efficacy and safety are superior to pingyangnwcin, especially applicable to the elderly patients with chronic dacryocystitis, which can not be implemented or not willing to operation with systemic complications,and has the important clinical value.