断端难寻找的上下泪小管均断裂的手术体会

Experiences on treatment of lacrimal canaliculus laceration with hidden ends of both upper and lower rupture site

目的探讨上下泪小管均断裂并难以寻找断端时的手术方法及效果。方法对12例（12眼）外伤性上下泪小管均断裂者，经用多种方法仍找不到鼻侧断端，采用先切开泪囊，分别逆行寻找上下泪小管鼻侧断端，然后用带双探针硅胶管行双路环形置管法吻合上下泪小管，观察术后远期效果。结果手术后拔管前患者存在轻度溢泪，异物感，少数内眦充血，硅胶管轻度移位，但无脱管者。拔管后随访观察3个月至1年，其中治愈10眼，泪道冲洗通畅，自觉无流泪，治愈率83．3％。有效2眼，偶有溢泪，冲洗泪道有狭窄，冲洗液部分返流，有效率16．7％。结论泪囊切开联合双路环形置管法治疗难以寻找鼻侧断端的上下泪小管同时断裂患者，手术直观，效果可靠，且支撑管隐蔽不影响外观，克服了术后下睑外翻及下泪点外翻的发生。

Objective To investigate the surgical methods and clinical efficacy for both ruptured upper and lower lacrimal canaliculi with the hidden broken ends. Methods For 12 eyes of 12 cases with both ruptured upper and lower lacrimal canaliculi after trauma, the nasal broken ends were not found by using various methods. The lacrimal sac was incised, retrograde seeking upper and lower canalicular nasal ends was done respectively, and then the upper and lower lacrimal canaliculus anastomosis was applied with dual ring method using a double probe silicone tube. The long-term curative effect after operation was observed. Results Before extubation after surgery, the patients had mild epiphora, foreign body sensation, inner canthus hyperemia, slight shift of silicone tube. There was no dropout of tube. The patients were followed up for 3 months to 1 year after extubation, 10 eyes were cured without tearing, lacrimal duct was unobstructed, and the cnre rate was 83.3%. Two eyes were treated effectively with occasional epiphora, stenosis of lacrimal passage with part reflux of washing liquid, and the relative cure rate was 16. 7%. Conclusion Lacrimal sac incision combined with double circular tube method in the treatment of both upper and lower lacrimal canaliculi ruptured with hidden nasal broken ends is intuitive and reliable. The concealed supporting tube which does not affect the postoperative appearance, and it avoid the lower eyelid and lower puncture ectropion.