泪小管前壁切除支撑管置入术治疗泪小管炎

Resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis

目的研究泪小管前壁切除联合泪道支撑管置入术治疗泪小管炎的临床效果。方法距内眦睑缘3mm平行切开眼睑皮肤，暴露膨大脓肿的泪小管，水平切开泪小管，清除泪小管内脓性分泌物、结石及肉芽组织。一根软性硅胶支撑管的两端分别从上下泪点置入泪道，经泪囊、鼻泪管一同进入鼻腔并将两端打结。切除多余扩张的水平部分泪小管前壁，用8—0可吸收缝线间断缝合残余的泪小管后壁，包绕支撑管，重建泪小管。术后观察6～12个月。结果术后1周拆除皮肤缝线，3个月取出泪道支撑管。术后6—12个月全组34例（34眼）中32例（32眼）泪道冲洗畅通，占94．12％，2例泪小管再阻塞，其中1例（1眼）系术后1周泪道支撑管脱落。全部无流脓，泪小管无红肿，泪点开放，睑缘复位。结论泪小管部分管壁水平切除联合泪道支撑管植入术，重建泪小管恢复泪道引流功能，疗效良好，不易复发，是治疗泪小管炎尤其下泪小管炎较好的手术方法。

Objective To study the clinical efficacy of resection of anterior canalicular wall and lacrimal stent intubation for lacrimal canaliculitis. Methods A paralleling eyelid incision about 3 mm away from the margin was performed to expose the bulgy canaliculus. The canaliculus was cut parallelly and the purulent secretion, calculus and granulation tissue were removed. The two ends of a soft silicone stent were implanted via the superior and inferior punctum and were pulled out from nasal cavity where they were tied. The redundant dilated anterior wall canaliculus was resected and the posterior wall was sutured with 8 -0 absorbable suture for wrapping up the stent. The follow-up time was 6 - 12 months. Results The suture of the skin was removed 1 week after the operation, and the stent was taken out 3 months after the operation. After follow- up of 6 -12 months, the lacrimal passages were irrigated successfully on 32 cases （32 eyes） among the total 34 cases（34 eyes）, accounting for 94.12%. Two patients had recurrent lacrimal passage obstruction, and it caused by stent falling off one week after the operation in one patient. The canaliculus had no purulence with open puncta and resetting eyelid. Conclusion Canaliculus hemisection combined with lacrimal stent intubation is an effective way with low recurrent rate for treating canaliculitis and reconstructing the canaliculus, especially for inferior canaliculitis.