RS型泪道再通管与硬膜外麻醉管在泪小管断裂吻合术中的应用比较

Comparison of the clinical outcomes for lacrimal canalicular rupture with RS-type lacrimal tube and epidural anesthesia tube

目的:观察RS型泪道再通管与硬膜外麻醉管在泪小管断裂吻合术中的疗效。方法:将泪小管断裂患者82例(82眼)按就诊时间先后顺序,随机分成两组:A组(硬膜外麻醉管组)40眼,B组(RS型泪道再通管组)42眼;两组患者均3月左右拔管,比较泪道通畅、泪小管撕裂、眼睑外翻、眼睑内眦角畸形等方面的情况。结果:两组临床疗效比较,A组(硬膜外麻醉管组)中30例治愈(75.00%),6例好转(15.00%),4例未愈(10.00%),治疗有效率为90.00%;B组(RS型泪道再通管)中36例治愈(85.71%),5例好转(11.90%),1例未愈(2.38%),治疗有效率为97.62%,差异无统计学意义(χ2=0.960,P>0.05)。两组并发症比较,A组下泪点及眼睑轻度外翻8例(20.00%),泪小管撕裂5例(12.50%),泪道置管脱落6例(15.00%),内眦角畸形8例(20.00%),并发症总发生率67.50%;B组下泪点及眼睑轻度外翻1例(2.38%),泪小管撕裂1例(2.38%),泪道置管脱落0例(0%),内眦角畸形2例(4.76%),并发症总发生率9.52%,差异有统计学意义(χ2=29.288,P<0.001)。结论:RS型泪道再通管和硬膜外麻醉管在泪小管断裂吻合术中应用效果均良好,但RS型泪道再通管在眼睑并发症等方面均优于硬膜外麻醉管,RS型泪道再通管是一种理想的留置物。

Objective：To compare the clinical efficacies of repairing lacrimal canalicular laceration with either RS-type lacrimal intubation or epidural an-esthesia intubation.Methods：Eighty-two patients （82 eyes） with lacrimal canaliculi rupture were divided into group A （40 eyes,treated with epidural an-esthesia intubation） andgroup B （42 eyes,treated with RS-type lacrimal intubation）.Extubation was carried out in about 3 months after procedure.The two groups were observed regarding incidences of lacrimal duct obstruction,cancalicular laceration,ectropion and deformity of eyelid canthal angle.Results：Thirty eyes were cured（75.00%）,6 improved（15.00%） and 4 failed（10.00%） in group A.The effective rate was 90%.Successful repair was in 36 eyes （85.71%）,improvement was in 5（11.90%） and failure in （2.38%） in group B.The effective rate was 97.62%.However,the clinical efficacy was not sig-nificantly different between groups（χ^2=0.960,P〉0.05） .The complications were associated with minor eversion of lower lacrimal point and eyelids in 8 eyes（20.00%）,cancalicular laceration in 5 eyes （12.50%）,dislocation of lacrimal intubation in 6 eyes（15.00%） and deformed eyelid canthal angle in 8 eyes（20.00%） in group A,and minor eversion of lower lacrimal point and eyelids in 1 eye（2.38%）,cancalicular laceration in 5 eye （2.38%）,dislocation of lacrimal intubation in 0（0.00%） and deformed eyelid canthal angle in 2 eyes（24.76%） in group B.The total complications were 67.50%and 9.52%for group A and B,and the difference was significant （χ^2=29.288,P〈0.001）.Conclusion：RS-type lacrimal intubation and epidural anesthesia intubation may lead to favorable clinical efficacies for management of lacrimal canalicular rupture ,yet the former has fewer complications than the latter .