泪点栓和泪小管栓置入术后继发泪小管炎的检查与治疗方法研究

Diagnosis and treatment of canaliculitis secondary to punctal and canalicular plug implantation

目的探讨泪点栓和泪小管栓置入术后继发泪小管炎患者的临床诊治方法及其疗效。方法收集2014年1月至2015年1月河南洛阳博爱眼科医院60例(91只眼)泪点栓和泪小管栓置入术后继发泪小管炎患者的临床资料。按照数字表法随机将患者分为研究组30例(45只眼)和对照组30例(46只眼)。对照组患者采用常规诊治方法进行治疗;研究组患者给予超声生物显微镜(UBM)检查,并结合检查结果制定治疗方案,比较两组患者的治疗效果。两组患者的阳性诊断情况、异物情况、泪小管切开情况及泪道栓取出情况以例数和百分率的形式表示,并采用χ2检验的方法进行比较。结果研究组检查结果为阳性者30例(45只眼),占100%;发现异物者30例(45只眼),占100%;泪小管切开者15例(23只眼),占50%;泪小管未切开者15例(22只眼),占50%;泪道栓取出者30例(45只眼),占100%。对照组检查结果为阳性者28例(42只眼),占93.3%;检查结果为阴性者2例(4只眼),占6.67%;发现异物者29例(44只眼),占96.67%;未发现异物者1例(2只眼),占3.33%;泪小管切开者11例(22只眼),占36.37%;泪小管未切开者19例(23只眼),占63.33%;泪道栓取出者26例(40只眼),占86.67%;泪道栓未取出者4例(6只眼),占13.33%。两组患者的治疗效果比较,差异有统计学意义(χ2=7.03,6.04,8.03,7.04;P<0.05)。结论应用UBM对泪点栓和泪小管栓置入术后继发泪小管炎的患者进行检查,可准确显示其泪道栓的存留位置,提升临床治疗效果,安全有效,值得临床推广。

Objective To optimize the diagnosis and treatment of canaliculitis secondary to punctal and canalicular plug implantation. Method hospital total of 60 patients（ 91 eyes） with canaliculitis secondary to punctal and canalicular plug insertion were recruited between January,2014 and January,2015.They were randomized to a control group（ 30 patients,46 eyes） and an experimental group（ 30 patients,45 eyes）. In the control group,the conventional diagnostic and treatment modalities were adopted. In the experimental group,ultrasound biomicroscopy was applied in addition to the conventional diagnostic methods in the diagnosis and endoscopic lacrimal surgery in combination with medical therapy was performed in the treatment. Data on the positive diagnosis,foreign body incidence,canalicular incision and plug removal were collected and analyzed. Results In the experimental group,positive diagnosis rate was 100%,foreign body identification rate was 100%,canalicular incision was performed in 15（ 50%） patients and foreign body removal rate was 100%. In the control group,positive diagnosis rate was 93. 33%,foreign body removal rate of 96. 67%,canalicular incision rate was 36. 37% and punctal plug removal rate was 86. 67%. The differences in all these variables were significant between the two groups（ χ2= 7. 03,6. 04,8. 03,7. 04; P〈0. 05）. Conclusion Ultrasound biomicroscopy can improve the accuracy of clinical diagnosis of canaliculitis secondary to punctal and canalicular plug implantation,help determine the plug retention position,and consequently improve treatment outcome.