全麻下儿童泪小管断裂吻合联合环形硅胶管植入术的临床观察

Pediatric canalicular laceration repairs combined with intubation under general anesthesia

目的探讨全麻下儿童泪小管断裂吻合联合环形硅胶管置入的手术方法并观察术后疗效。方法我院2011年1月至2014年12月住院手术的外伤性泪小管断裂患儿22例（22只眼）,年龄14个月~12岁,受伤后2 d内手术16例,3 d 4例,7 d1例,最长在受伤后2周。全麻后显微镜下寻找泪小管鼻、颞侧断端,带橄榄头的双探针硅胶管分别从上下泪小点插入,经泪小管断端,穿过鼻泪管并从鼻腔钩出打结成环形。用8-0可吸收缝线缝合断端泪小管壁连同周围组织2~3针。术后随访6个月。结果显微镜下顺利完成手术。术中2例泪小点撕裂,用9-0尼龙线缝合,术后愈合。1例术后3天硅胶管脱落,一直溢泪。3个月后拔除泪道环形硅胶管并冲洗泪道,1例在拔管后1个月泪道冲洗不通,患儿溢泪。除上述2例泪道阻塞外,其余20例泪道通畅,眼睑皮肤愈合好。结论儿童泪小管断裂在全麻下顺利完成泪小管端端对位吻合,经上下泪小点置管有一定难度,可确保较高成功率,术后患儿几无刺激症状,疗效好,是较理想的手术方法。

Objective To investigate the surgical approach of repairing pediatric canalicular laceration combining with intubation under general anesthesia and observe the clinical effect.Methods 22 hospitalization cases of pediatric canalicular laceration were collected between Jan 2011 and Dec 2014.Age ranged from 14 m to 12 y.16 cases were treated within 2d after injury,while 4 cases within 3d,1 case within 7d.The longest repairing time was 2w after injury.All microscopic surgeries were performed under general anesthesia.The nasal the temporal broken ends of the canaliculi were found.Double stent silicone tube with olive head were insert into the upper and lower puncta respectively,then passed though the nasal the temporal broken ends of the canaliculi,nasolacrimal duct and finally were hooked from the nasal cavity.The silicone tube was tied to form a ring-shape.The canaliculus wall of the two ends together with the around tissue were sutured with 8-0 vicryl for 2 to 3 stitches.With 6 months follow-up.Results All the surgeries were carried out under microscopy.The puncta of 2 cases tear during the operation,and sutured with 9-0 nylon.All the two cases healed well after surgery.One case dropped the silicone tube 3d postoperatively and kept tearing after that.The silicone tube was removed 3m after surgery following with irrigation.One case had lacrimal obstruction 1m after tube removal and presented with tearing.2 cases got loss during following up time.All the other 20 cases presented with patency lacrimal duct and eyelid wound well healing.Conclusions The key point of the surgery was anastomosis of the two broken ends of canaliculi in position under general anesthesia.Intubation through the upper and lower puncta and anchored in the nose could make sure the success rate of the surgery.The surgery must be performed careful under microscope.All children presented free irritation postoperatively.Stent removal carried out easily.It was an ideal approach to repair canaliculus laceration with an excellent effect.