不同吻合环形置管术治疗泪小管断裂的疗效研究

Comparison of different types of catheter treatment of anastomotic ring canalicular effect

目的:探讨不同吻合环形置管术治疗泪小管断裂疗效。方法:采用回顾分析法。选取2013-05/2015-05惠州市第一人民医院和惠州市中心人民医院共同收治的泪小管断裂患者114例114眼,按照吻合环形置管方法的不同分为三组,A组为泪道鼻腔环形置管36眼,B组为鼻内全泪道环形置管术33眼,C组为上下泪点间环形置管术45眼。观察三组术后1、3wk,1、3mo,1a的随访情况进行分析比较。结果:A组治愈31眼,好转2眼,无效3眼,有效率为91.7%;B组治愈27眼,好转3眼,无效3眼,有效率为90.9%;C组治愈40眼,好转2眼,无效3眼,有效率为93.3%。三组有效率差异无统计学意义(P=0.124)。眼部影响:三组间的比较差异有统计学意义(F=36.578,P=0.002),A组得分最高,C组得分最低,分别为3.5±0.8、2.3±0.7分,A组和B组间的对比差异无统计学意义(t=0.086,P>0.05);A组和C组及C组和B组的对比差异均有统计学意义(t=15.241、17.472,均P<0.05)。鼻部影响:三组间的比较差异有统计学意义(F=778.581,P=0.001),B组得分最高,C组得分最低,分别为6.6±0.8、0.9±0.7分;三组间两两对比差异均有统计学意义(t=17.262、18.247、16.647,均P<0.05)。外形影响:三组间的比较差异有统计学意义(F=481.113,P=0.002),A组得分最高,C组得分最低,分别为5.8±0.9、1.2±0.6分;B组和C组间的对比差异无统计学意义(t=0.087,P>0.05);A组和C组间及A组和B组间的对比差异均有统计学意义(t=26.362、27.532,均P<0.05)。拔出风险:三组间的比较差异有统计学意义(F=751.121,P=0.003),A组得分最高,C组得分最低,分别为6.5±0.7、1.5±0.7分;三组间两两的对比差异均有意义(t=19.642、20.153、18.345,均P<0.05)。A组出现下睑外翻8眼,下泪小点扩张5眼,出现打喷嚏、鼻痒、流涕症13眼。B组出现不同程度的现打喷嚏、鼻痒、流涕症20眼。C组没有出现严重并发症。结论:三组的治疗方案疗效类似,对患者泪道的功能恢复安全有效,其中上下泪点间环形置管术治疗过程中材料使用少,且术后患者的并发症少。

AIM： To investigate the comparison of different types of catheter treatment of anastomotic ring canalicular effect. METHODS：Retrospective analysis. A total of 114 cases 114 eyes were randomly selected between May 2013 to May 2015 jointly admitted to Huizhou Huizhou City People＇s Hospital and the Central People＇s Hospital of canalicular patients in accordance with the agreement of the annular catheterization divided into three groups, group A of annular nasal lacrimal duct catheterization in 36 eyes, group B for the whole nasal lacrimal annular catheterization in 33 eyes, group C between the upper annular tears point catheterization 45 eyes. Through the A, B, C three groups after 1, 3wk, 1, 3mo and 1y follow-up were analyzed to compare. RESULTS：Group A of 31 eyes were cured, improved in 2 eyes, 3 eyes, the effective rate was 91. 7%;group B, 27 cases were cured, improved in 3 eyes, 3 eyes, the effective rate was 90. 9%;group C, 40 cases were cured, improved in 2 eyes, 3 eyes, the effective rate was 93. 3%. A, B, C three groups efficiency pointless difference （P=0. 124）. Eye Effect： A, B, C meaningful difference among the three groups（F=36. 578; P=0.002）, Group A scored the highest score of a minimum group C, respectively（ 3. 5±0. 8 ） and （ 2. 3±0. 7 ）; comparisonmeaningless difference between group a and group B（ t=0. 086, P〉0. 05 ）; Group A and C and comparison of differences between group C and group B have the significance （ t = 15. 241, t = 17. 472; P〈0. 05 ）. Nasal influence： A, B, C meaningful difference among the three groups（F=778. 581;P=0. 001）, the highest score in group B, group C minimum scores were（6. 6±0.8） and （ 0. 9 ± 0. 7 ）; A, B, C three groups comparison of differences twenty-two have significance（t=17. 262; t=18.247; t = 16. 647; P〈0. 05）. Shape Effect： A, B, C difference among the three groups of meaningful （ F=481. 113;P=0. 002）, Group A scored the highest score of a minimum group C, respectively（5. 8±0. 9） and（1. 2±0.6）;Compare the difference between Groups B and C meaningless （ t = 0. 087, P 〉 0. 05 ）; comparing the differences between the Groups A and B and between Group A and C were significance（t=26. 362, t=27. 532; P〈0. 05 ）. Unplug risk： A, B, C meaningful difference among the three groups（F=751. 121;P=0. 003）, Group A scored the highest score of a minimum group C, respectively（6. 5±0. 7 ） and （ 1. 5±0. 7 ）; A, B, C three groups comparison of differences twenty - two have significance（t=19. 642; t=20. 153; t=18. 345; P〈0. 05）. Group A had 8 patients had lower eyelid eversion, 5 cases of inferior lacrimal point expansion, 13 cases of sneezing, itchy nose, runny nose syndrome. Group B had 20 cases of varying degrees of now sneezing, itchy nose, runny nose syndrome. Group C had no serious complications. CONCLUSION： Similar to A, B, C three groups of treatment efficacy, patient lacrimal functional recovery is safe and effective, which the group C treatment, during treatment and less material and fewer postoperative complications in patients, it is worth promotion.