泪道激光吻合口成形与U形泪道扩张管植入治疗复发泪囊炎分析

Clinical analysis of laser-assisted artificial nasolacrimal duct implantation for treatement of postoperative recurrence of dacryocystorhinostomy

目的 评价泪道激光吻合口成形,联合U形泪道扩张管用于泪囊鼻腔吻合术后复发病例的临床效果.方法 回顾性对比分析2008年1月至2012年1月间在解放军第四七四医院全军眼科中心就诊的41例（41只眼）泪囊鼻腔吻合术后复发病例.其中,采用泪道激光吻合口成形联合U形泪道扩张管植入术治疗17例为观察组;采用二次泪囊鼻腔吻合术24例为对照组.评价标准：观察组术后3个月拔管,拔管后2个月复查;对照组术后2个月复查,流泪症状消失并冲洗泪道通畅为治愈;流泪但冲洗泪道不全堵塞为好转;流泪并冲洗泪道完全堵塞为失败;治愈和好转合计为有效.采用SPSS 11.0统计软件进行数据处理分析,对组间治愈率和有效率比较行彭检验.结果 观察组治愈12例（70.59％,12/17）,好转2例（11.76％,2/17）,计有效14例（82.35％,14/17）;失败3例（17.65％,3/17）.对照组治愈9例（37.50％,9/24）,好转8例（33.33％,8/24）,计有效17例（70.83％,17/24）;失败7例（29.17％,7/24）.两组间治愈率差异比较有统计学意义（x2=4.3606,P=0.039）;两组间有效率差异比较无统计学意义（x2=0.2276,P=0.43）.结论 泪道激光吻合口成形联合U形泪道扩张管植入术用于泪囊鼻腔吻合术后失败病例,可以取得满意效果.对比二次泪囊鼻腔吻合术,具有操作简便、损伤小、安全性好、患者痛苦小、治愈率高的优点,值得临床进一步研究应用.

Objective To explore the clinical effectiveness of laser-assisted artificial nasolacrimal duct implantation in the anastomois recanalization to treating recurrent dacryocystitis.Methods The clinical data of 41cases （41 patients） with recurrent dacryocystitis were retrospective analyzed,17 cases treating with laser-assisted artificial nasolacrimal duct implantation to recanalizing the anastomois,which was the observation group,24 cases treating with second traditional dacryocystorhinostomy,which was control group.All cases were diagnosed recurrent dacryocystitis after first dacryocystorhinostomy from 3 to 25 months.Evaluation standard：observation cases were followed up for 2months after pull out the duct,which had been remained 3 month; control cases were followed up 2 months after operation.Cure standard was no tear running and no obstruction of lacrimal duct,improved standard was tear running and obstruction of lacrimal duct,invalid standard was tear running and obstruction of lacrimal duct,effective standard was cured or improved.Results In the observation group,12 cases were cured 70.59%,2 improved 11.76%,3 invalided; effective rate was 82.35%,invalid rate was 17.65%.In the control group,9 cases were cured,8 cases were improved,7 cases were invalided,cure rate was 37.50%,improved rate was 33.33%,effective rate was 70.83%,and invalid rate was 29.17%.The cure rate in the observation group was significantly great than that in the control group （x2 4.3606,P 0.039）,the effective rate between the observation group and the control group had no statistical significances （x2 0.2276,P 0.43）.Conclusions The laser-assisted artificial nasolacrimal duct implantation can be used to treat postoperative recurrence of dacryocystorhinostomy with good result,compared with second dacryocystorhinotomy,it is a safe,simple and effective way with high cure rate.The laser-assisted artificial nasolacrimal duct implantation is worth studying and popularizing.