改良泪道支撑管治疗泪小管断裂的效果

IMPROVED LACRIMAL DUCT-SUPPORT TUBE IN TREATING LACRIMAL CANALICULUS RUPTURE:ITS CLINICAL EFFICACY

目的探讨系＂红领巾结＂式缝合及隐匿硅胶支撑管方式修复泪小管断裂的临床效果。方法回顾性分析18例（18眼）采用系＂红领巾结＂式缝合及隐匿硅胶支撑管方式修复泪小管断裂病人的临床资料。18例中单纯下泪小管断裂16例,上下泪小管断裂2例。手术在显微镜下按照眼睑解剖结构找到泪小管断端,以0.6 mm外径空心硅胶软管作为支撑物,系＂红领巾结＂式缝合泪小管2针（其中1针固定缝合硅胶管）,轻拉硅胶软管平泪小点剪断使之回退至泪小管水平部。术后随访6个月。结果 18眼均吻合成功。所有病例下睑伤口愈合好,下睑和泪小点位置正常,硅胶管回退至泪小管水平部,外观舒适,置管期间病人自觉无溢泪。硅胶管在1~2个月自行脱落13例,在鼻内镜下取出5例。去除支撑物后,16例无不适及溢泪,冲洗泪道通畅,治愈率88.89%;2例下睑自觉溢泪,冲洗泪道通而不畅,好转率11.11%。结论改良系＂红领巾结＂式缝合及隐匿硅胶支撑管方式修复泪小管断裂,对泪道损伤小且支撑管不外漏,不影响病人外观,值得推广应用。

Objective To evaluate the clinical effect of ＂red-scarf＇-pattern suturing and concealed supporting silicon tube on repairing lacrimal canaliculus rupture. Methods A retrospective review was conducted for clinical data of 18 cases （18 eyes） of lacrimal canaliculus rupture （LCR） treated with the ＂red-scarf＂-pattern suturing and concealed supporting silicon tube. Of the 18 cases reviewed, simple lower LCR was recorded in 16 cases, and both lower and upper LCR were noted in two cases. Surgery was done under a microscope, the broken ends of lacrimal canaliculi were found according to the anatomical structure. Using a silica gel collapsible tube （outside diameter of 0.6 ram） as a staddle, and two ＂red-scarf＂-pattern suturing were done on lacrimal canaliculi, one of that was used to fix the silicon tube. The tube was then gently pulled to the horizontal part of lacrimal canaliculi and sheared. A post-operative follow-up was conducted for six months. Results The surgery was succeeded in all the 18 cases. The wounds of lower eyelids were healed well in all cases, the location of lower eyelids and puncta were normal, the silicone tubes rollbacked to horizontal position of lacrimal canaliculi and the appearance was comfortable, no epiphora during the period of implantation of sili- con tube in most of the cases. The silicon tube automatically separated in 13 cases within 1--2 months, of which, the tube was re- moved in five cases under a nasal endoscope. After removing the staddle, no complaints and overflow tear were observed in 16 ca- ses, lacrimal passage was not obstructed while washing, cure rate being 88.89%. Epiphora was recorded in two cases, rinsing indi- cated that lacrimal passages were through but not free, the improvement rate being 11.ii o~. Conclusion The modified ＂red- scarf＂-suturing and concealed supporting silicon tube for repairing rupture of lacrimal canalieulus causes little damage to lacrimal passages and no leakage from the supporting tubes, which does not impact the appearance of patients and it is worth popularizing and applying.