泪道内窥镜下环钻泪道成形联合置管术治疗泪道阻塞的临床观察

Clinical outcomes of microdrill recanalization and intubation under lacrimal endoscope to treat lacrimal passage obstruction

目的探讨泪道内窥镜下环钻泪道成形联合环形硅胶管置入术治疗泪小管阻塞、泪总管阻塞、鼻泪管阻塞的临床疗效。方法收集2011年5月至2012年5月入院治疗的单纯性泪道阻塞患者54只眼，其中泪小管阻塞12只眼，泪总管阻塞14只眼，鼻泪管阻塞28只眼。所有病例泪道冲洗无分泌物，术前先行泪道探通，鼻泪管阻塞者探通阻力小、泪小管及泪总管节段阻塞〈3mm为手术对象。泪道内窥镜下微型环钻泪道再通术，并置入泪道引流管。随访6个月，观察术后泪道通畅情况。结果2只眼鼻泪管阻塞者术后1-2个月泪囊有分泌物提前拔管，其余病例术后3个月拔管并泪道冲洗通畅。随访6个月，泪道冲洗通畅45只眼，治愈率达83．3％；好转5只眼（9．3％）；无效4只眼（7．4％），其中2只眼为泪小管再阻塞，2只眼为鼻泪管阻塞者。结论选择泪道探通阻力小、阻塞节段短的泪小管阻塞、泪总管阻塞、鼻泪管阻塞患者行泪道内窥镜下环钻泪道成形联合置管术疗效好，损伤小，并发症少，成功率高。

Objective To evaluate the outcomes of micredrill recanalization and intubation under Lacrimal endoscope to treat obstructions in common or individual eanaliculi or lacrimal ducts. Methods Fifty-four patients with lacrimal passage obstruction were recruited between May 2011 and May 2012. Diagnosis included lacrimal canaliculi obstruction （ 12 eyes）, common canaliculi obstruction （ 14 eyes） and lacrimal duct obstruction （28 eyes）. Probing and irrigation are performed before the surgery. Following criteria were used to select subjects in this study： no discharges with irrigation, small resistance with probing in patients with obstruction in nasolacrimal duct, or less than 3 mm in length in the patients with obstructious in common or individual canaliculi. All patients received lacrimal passage microdrill recanalization and intubatlon under lacrimal endoscope. Patency of the lacrimal passage was evaluated in the following 6 months. Results The silicone tube was removed within 1 month after surgery （ ahead of the scheduled time ） in two patients with nasolacrimal duct obstruction because of discharge from the ducts. All other patients had the tube removed at 3 months as scheduled and had a patency lacrimal passage. At the 6th month, treatment was successful （45 eyes, recovery rate 83.3% ） or brought improved improvement （ 5 eyes, 9.3 % ） in majority cases; the surgery did not succeed in 4 eyes （7.4% ）, in which two eyes presented with individual canaliculi reocclusion and 2 eyes presented with lacrimal duct re-occlusion. Conclusion Microdrill recaualization and intubafion under lacrimal endoscope is an effective and safe way to treat the following conditions： lacrimal duct obstruction with little resistance in probing, individual canaliculi obstruction not longer than 3 ram, and obstruction in common canaliculi.