先天性鼻泪管阻塞治疗方法及泪道探通时机探讨

Method and probing of lacrimal passages time in congenital nasolacrimal duct obstruction

目的探讨先天性鼻泪管阻塞的有效治疗方法及泪道探通时机。方法回顾性分析2012年1月至2014年6月在濮阳市眼科医院就诊的先天性鼻泪管阻塞的患儿618例（747眼）,首诊年龄1周~6岁,平均4.2个月。根据首诊年龄和症状分为≤6月龄和〉6月龄两组进行观察,依次采取保守治疗、加压泪道冲洗和泪道探通法治疗,经随访3~24个月,观察两组的治疗效果。治愈标准为无溢泪、无分泌物、泪道冲洗通畅。术后仍然流泪、伴分泌物、泪道冲洗不畅为无效。结果≤6月龄组1次探通成功率为97.4%,〉6月龄组1次探通成功率为87.5%,两组比较差异有统计学意义（χ~2=23.38,P〈0.01）。保守治疗的有效率为8.0%,加压泪道冲洗法的有效率为10.5%,泪道探通法的有效率为96.3%,差异有统计学意义（P〈0.01）。结论泪道探通法治疗先天性鼻泪管阻塞安全有效,年龄越小手术治愈率越高,最佳泪道探通时机为2~6月龄。

Objective To evaluate the effective treatment and time of probing of lacrimal passages in congenital nasolacrimal duct obstruction. Methods A retrospective study was taken on 618 children（ 747 eyes） with congenital nasolacrimal duct obstruction aged from 1 week to 6 years according to the age and symptom at first examination. All the cases were divided into two groups： ≤6 months group and 〉6 months group. The mean age at first examination was 4. 2 months. Children were treated with conservative treatment,high-pressure irrigation or probing of lacrimal passages. They were all followed up for 3 to 24 months,and the mean time was 6. 4 months. Successful cases were defined with absence of symptoms and signs like tearing,crusting,and discharge,regurgitation with pressure on the lacrimal sac. Results The success rate by once probing was 97. 4%in ≤6 months group and 87. 5% in 〉6 months group,and there was significant difference between the two groups（ χ~2= 23. 38,P〈0. 01）. With conservative treatment,60 eyes were recovered in all 747 eyes,the effective rate was 8. 0%; 72 eyes were recovered in all 687 eyes with high-pressure irrigation,the effective rate was 10. 5%; 592 eyes were recovered in all 615 eyes with probing of lacrimal passages,the effective rate was 96. 3%; 15 eyes failed,the differences were significant（ P〈0. 01）.Conclusion Probing of lacrimal passages is a safe and effective methed in congenital nasolacrimal duct obstruction. 2 to 6months is the best time for first time probing,and the success rate declined as the children become older.