逆行置管术治疗鼻泪管阻塞的临床研究

Retrograde intubation procedure in the treatment of nasolacrimal duct obstruction

目的探讨泪道逆行置管术治疗成人鼻泪管阻塞的疗效及骨性鼻泪管解剖因素对疗效的影响。方法71例（75眼）成人原发性鼻泪管阻塞，术前行CT三维成像测量骨性鼻泪管的长度及最小直径，然后分别经鼻泪管逆行植入“Y”形泪道引流硅胶管，术后3～6个月拔出，随访1年以上。结果75眼均一次置管成功。拔管时泪道冲洗通畅67眼（89．33％），冲洗有阻力8眼（10．67％）。拔管后1—3个月内有14眼再次阻塞（18．67％）。术前泪道CT三维成像测量结果统计学分析显示，治愈组与未愈组骨性鼻泪管平均长度：分别为（13．40±0．51）mm和（13．71±0．41）mm，骨性鼻泪管最小直径：分别为（3．47±0．34）mm和（3．23±0．28）mm差异均有统计学意义（t=4．81，t=5．64，P〈0．01）。结论泪道逆行置管术是治疗成人鼻泪道阻塞的较好方法。术前CT三维重建了解患者骨性泪道解剖特点，制定个性化治疗方案，可以提高泪道逆行置管术治愈率。

Objective To investigate the influence of bony lacrimal passage anatomy in the man- agement of nasolacrimal duct obstruction treated by retrograde intubation procedure. Methods 75 eyes of 71 cases of primary nasolacrimal duct obstruction in adults were studied. The patients underwent three-di- mensional CT imaging before surgery to detect the length and minimum diameter of bony lacrimal passage. The Y shape silicone tubes were intubated in lacrimal passages retrogradely. The tubes were removed at 3 months after surgery. The patients were followed up for over 1 year. Results The tubes were intubated successfully by one surgery in all cases. When the tubes were removed, saline irrigation revealed complete free passages in 67 eyes （ 89.33% ） and some blockage in 8 eyes （ 10.67% ）. At 1 - 3 months after removal of the tubes, eanalieular obstructions were found in 14 eyes. These 14 cases were regarded as the uncured group and other 61 eyes were regarded as the cured group. The average lengths of bony lacrimal passage were （ 13.40 ± 0.51 ）mm in the cured group and （ 13.71 ± 0.41 ） mm in the uncured group. The minimum di- ameters of bony lacrimal passage were （ 3.47 ± 0.34 ） mm in the cured group and （ 3.23±0.28 ）mm in the uncured group. The differences of average lengths and minimal diameters of bony lacrimal passage in two groups were statistically significant （ t = 4. 81, P 〈 0. 01 ; t = 5.64, P 〈 0.01 ）. Conclusion Retrogarde intubation procedure has good clinical efficacy in the treatment of nasolaerimal duct obstruction. The indivi- dual operation should be designed based on the three-dimensional CT imaging of bony lacrimal passage to in- crease the success rate of surgery.