逆行人工鼻泪管植入术治疗泪囊瘘疗效观察

Curative effect observation of retrograde artificial nasolacrimal duct implantation in the treatment of lacrimal sac fistula

目的观察逆行人工鼻泪管植入联合皮肤瘘道切除术治疗泪囊瘘的临床疗效。方法选择2009年1月至2014年3月在南昌大学第二附属医院就诊的泪囊瘘患者52例（52只眼），均为女性，年龄35。85岁，局麻下行逆行人工鼻泪管植入联合皮肤瘘道切除术，术后随访时间1～48月。结果术后52例患者溢泪、溢脓症状完全缓解，随访1～6月，52例冲洗通畅，流泪、溢脓症状消失，总有效率100％。随访12～24月52例中18例出现溢泪症状，经过探通、激光处理症状消失，2例经过处理后症状未能消失，改行泪囊鼻腔吻合术，术后溢泪症状消失，总有效率96．2％。经36～48月随访（包括电话随访）52例中失访17例，余35例中10例出现溢泪症状，经过探通、激光处理症状消失，3例溢泪、溢脓，无法缓解，行泪囊鼻腔吻合术后症状消失，总有效率91．4％。结论逆行人工鼻泪管植入术为泪囊瘘患者提供了一种安全，简便、有效的手术方法。

Objective To observe therapeutic effect of implantation of artificial nasolacrimal duct association with excision of skin fistula on treatment of lacrimal fistula. Methods Fifty-two patients （52 eyes） with lacrimal fistula that received retrograde artificial nasolacrimal duct implantation and excision of skin fistula from January 2009 to March 2014 in our hospital were selected and success- fully followed up from 1 month to 48 months after operation. All were female, aged from 35 years old to 85 years old. Results Complete remission of epiphora and Pyorrhea was observed in 52 pa- tients, followed up for a month, six months, artificial nasolacrimal ducts in 52 patients remained clear, the total effective rate was 100%; followed up from 12 months to 24 months （including tele- phone follow-up）, 18 patients appeared epiphora, the symptoms disappeared after treating with prob- ing and laser, two patients received dacryoeystorhinostomy who were appeared postoperative epiphora could not disappear by probing and laser, the total effective rate was 96.2%; followed up from 36 months to 48 months （17 eyes lost）, among the remaining 35 eyes （including telephone follow-up）, 10 patients appeared epiphora, the symptoms disappeared after treating with probing and laser, three patients received dacryocystorhinostomy who were appeared postoperative epiphora could not disap- pear by probing and laser, the total effective rate was 91.4%. Conclusions Retrograde implantation of artificial nasolacrimal duct provides a secure, convenient and effective surgical technique for the lacrimal fistula patients.