泪道激光再造联合泪道逆行置管治疗泪道阻塞

Clinical observation of Nd:YAG laser dacryocystoplasty with retrograde placement of lacrimal drainage tube for lacrimal duct obstruction

目的：观察Nd：YAG泪道激光再造成形联合泪道逆行置管术治疗泪道阻塞的临床疗效及影响手术效果的因素。 方法：选取20例23眼泪道阻塞患者行Nd： YAG激光再造成形联合逆行泪道引流管留置3 mo ，拔管后随访3～12 mo ，观察术前患侧鼻腔情况，术中鼻腔损伤程度、术后流泪和流脓情况、泪道功能恢复及并发症情况。 结果：末次随访时，经此方法治疗各种泪道阻塞的患者治愈19眼（82．6％）；有效2眼（8．7％）；无效2眼（8．7％），总有效率91．3％。其中泪小管阻塞者有效率100％（2/2），泪总管阻塞者有效率100％（15/15），鼻泪管阻塞者有效率66．7％（2/3），泪小管合并鼻泪管阻塞者有效率66．7％（2/3）。1眼术后2wk左右有轻微眼部刺激症状，3眼出现泪小管周围组织红肿不适，2眼出现泪小点撕裂，无1例患者出现假道及泪道插管滑脱，余未见其他并发症发生。 结论：泪道激光再造成形联合逆行泪道引流管留置术治疗泪道阻塞是一种有效的治疗方法。

AIM： To observe the clinical efficacy of Nd：YAG laser dacryocystoplasty with retrograde placement of lacrimal drainage tube for lacrimal duct obstruction and the influencing factors in the operation. METHODS：A total of 20 patients （23 eyes） with lacrimal duct obstruction were treated with Nd： YAG laser dacryocystoplasty with retrograde placement of lacrimal drainage tubes for 3 months.All patients were followed up for 3-12 months.Nasal cavity condition on the affected side before operation, nasal cavity injury in operation, lacrimation, suppuration, recovery of lacrimal passage function and complications after operation were observed. RESULTS： By the last following up, 19 eyes （ 82.6%） had been cured, 2 eye （ 8.7%） had improved, 2 eyes （8.7%） had no improvement.And the total effective rate was 91.3%.The effective rate was 100%（2/2） in patients with obstruction of lacrimal canaliculus, 100.00% （15/15） in patients with obstruction of lacrimal duct, 66.7%（2/3） in patients with obstruction of nasolacrimal canal, and 66.7% （ 2/3 ） in pateints with obstruction of lacrimal ductule and nasolacrimal canal.One eye was with mild irritation at about postoperative 2 weeks, 3 eyes presented with red swelling in surrounding tissues of lacrimal ductule, 2 eyes manifested with laceration of lacrimal punctum.No other complication was found. CONCLUSION： Laser dacryocystoplasty with retrograde placement of lacrimal drainage tube is a useful method for treatment of lacrimal duct obstruction.