NdYAG泪道激光成形术联合Fr-2泪道引流管置入治疗泪道疾病分析

Efficacy and complication of Nd.YAG lacrimal laser dacryocystoplasty combined with Fr-2 lacrimal drainage tube indwelling surgery for lacrimal duct disease

目的观察NdYAG泪道激光成形术联合Fr-2泪道引流管置入治疗泪道疾病的疗效及并发症。方法对2011年2月至2012年8月在成都中医院大学附属医院眼科就诊的148例（208只眼）泪道疾病患者行NdYAG激光成形联合Fr-2泪道引流管置入术，置管6个月后拔管并随访3个月，观察流泪、流脓情况、泪道通畅情况及有无并发症发生。结果除3例患者是单侧硅胶管置入外，其余患者均为上下泪小管环形泪道引流管置入，各种泪道阻塞患者治愈117只眼，好转38只眼，总有效率为74．52％，无效53只眼，占25．48％。并发症：15例（15只眼）m现内眦部红肿、刺痛、脓性分泌物，26例（26只眼）出现泪小管短小撕裂，1例（1只眼）出现上下泪小管全长撕裂，因假泪道形成致下鼻道中未发现探针仅单侧硅胶管置人3例（3只眼），6例（6只眼）泪道引流管从内眦部脱}}I，1例（1只眼）出现泪小管息肉，3例（3只眼）m现下泪点肉芽肿。无角膜擦伤和角膜溃疡发生。结论NdYAG泪道激光成形术联合Fr-2泪道引流管置入治疗泪道疾病是一种有效的治疗方法，但术后应密切随访，避免并发症发生。同时慢性泪囊炎患者中复发率较高，所以对长期慢性泪囊炎患者则建议行泪囊鼻腔吻合术。

Objective To observe the effectiveness and complication of laser dacryocystoplasty combined with Fr-2 lacrimal drainage tube indwelling surgery for lacrimal duct disease. Methods A total of 148 patients （208 eyes） with obstruction of lacrimal duct were treated with Nd YAG laser dacryocystoplasty combined with Fr-2 lacrimal drainage tube indwelling surgery for 6 months. All pa- tients were followed for 3 to 6 months, lacrimation, suppuration, lacrimal duct patency and complica- tions were observed. Results All the patients were bicanaliculus intubation stent with ring lacrimal drainage expect the 3 patients with unilateral silicone stent placed. Among those, 117 patients with different parts lacrimal duct obstruction were cured, improved in 38, total success rate was 74.52%, ineffective 53, accounted for 25.48%. Lacrimal stenosis treat efficacy was 100.00% （10/10）, canalicu- lus lacrimal obstruction treat efficacy was 92.30% （12/22）, lacrimal duct obstruction treat efficacy was 80.85% （38/47）, nasolacrimal tube obstruction treat efficiency was 76.92% （50/65）, canaliculus lacrimal merger noselacrimal duct obstruction treat efficacy was 66.67% （16/24）, and chronic dacryo- cystitis treat efficacy was 59.18% （29/49）. Complications were as the follows： 15 patients （15 eyes） showed visible inner canthus swelling, tingling, purulent discharge, 26 （26 eyes） canalicular partial tear, 1 （1 eye） appeared full-length canalicular tear, 6 （6 eyes） lacrimal drainage tube prolapse from the inner canthus, 1 （1 eye） canalicular polyps, 3 （3 eyes） puncta granuloma, no corneal abrasions and corneal ulcers occurred. Conclusions Nd.YAG laser forming of the lacrimal dacryocystoplasty combined with Fr-2 lacrimal drainage tube indwelling surgery for obstruction of lacrimal duct diseas- es is an effective treatment, and patients should be followed up closely to avoid complications. Pa- tients with chronic dacryocystitis have higher recurrence rate. It suggests that dacryocystorhinostomy is an effective technique to treat chronic dacryocystitis.