环形泪道引流管治疗泪小管断裂的临床疗效

Clinical study of drainage tube intubation and ring-fixed method on canalicular laceration

目的探讨在显微镜下采用环形泪道引流管置入治疗泪小管断裂的临床疗效。方法选择2013年1月至2015年1月在广州军区武汉总医院全军眼科中心收治N4,管断裂43例患者，在显微镜直视下寻找泪小管鼻侧断端，置入泪道引流管作为泪道内支撑物，吻合泪小管断端，并打结双环泪道引流管在鼻腔内，3月后拔管，拔管后3-6个月随访观察疗效及并发症。结果治愈40例（40／4393．02％），拔管后泪道冲洗通畅，无溢泪现象；2例（2／434．65％）主观自诉少许溢泪症状，但冲洗泪道通畅，行泪道扩张冲洗2次后症状消失；1例（1／432．33％）无效，患眼溢泪，泪道冲洗不畅。无眼睑内外翻、泪小管撕裂等并发症。结论在显微镜下容易找到泪小管鼻侧断端，采用环形泪道引流管置入治疗泪小管断裂是安全有效的方法，具有成功率高、刺激性小、美观等优点。

Objective To investigate the effectiveness of drainage tube intubation and ring-fixed method on canalicular laceration in microsurgery. Methods A retrospective review of 43 patients （43 eyes） whose eyes were diagnosed as canalicular laceration from January 2013 to January 2015. The surgical microscope was used to find canalicular nasal lateral ends. Drainage tubes as a lacrimal stent, the canaliculi breakage was anastomosed and the lacerated ends were knotted in the nasal cavi- ty. After 3 months drainage tubes were to pull out. Follow-up was done in 3-6 months after extuba- tion in order to observe the curative effect and complication. Results Forty cases （40/43, 93.02%） were cured, and lacrimal duct flushing after extubation were unobstructed, no tears spilt. Two cases （2/43, 4.65%） felt that a few tears spilt, but the wash of lacrimal duct test was unobstructed, and lacrimal duct expansion symptoms disappeared after washing 2 times. There were 1 case （1/43, 2.33%） in which the canaliculi were obstructed. No eye lid inside and outside, and the tube tear apart and other symptoms. Conclusions The technique of microsurgery for lacrimal ductile tear is easy to find the tears tubular nasal side ends, surgical success rate is high, drainage tubes intubation is a micro-invasive, beautiful outlook, safe and effective method.