下泪小管断裂吻合术单路置管与双路置管疗效比较

Comparison on clinical efficacy of anastomosis of inferion lacrimal canalicul laceration between monocanalicular and bicanalicular intubation

目的比较外伤性下泪小管断裂吻合术中单路置管术与双路置管术的临床疗效。方法回顾分析下泪小管断裂吻合术66例（66眼）。其中双路置管术3I例，单路置管术35例。两组均于术后3个月拔管，拔管后随访3个月，比较两种手术治愈率及并发症发生率。结果拔管后3个月，双路置管术组治愈20例，好转3例，无效8例，有效率74．2％；单路置管术组治愈27例，无效8例，有效率77．1％，两组间有效率比较差异无统计学意义（X^2=0．078，P=0．780）。术后双路置管术组共有8例出现下泪点撕裂，其中5例合并上泪点撕裂，单路置管术组未见泪点撕裂病例，泪点撕裂发生率两组比较差异有统计学意义（X^@=7．998，P=0．005）。结论两种置管术均有较好的临床治疗效果，单路置管术虽然短暂影响患者面部美观，但术后泪点无撕裂发生，保护了泪道的正常解剖结构，具有明显的远期优势。

Objective To compare the clinical efficacy of anastomosis of traumatic inferior canalicular lacerations between monocanalicular and bicanalicular intubation. Methods In a retrospective, nonrandomized comparative case series, 66 eyes of 66 patients with inferior canalicular lacerations from January 2012 to September 2015 underwent bicanalicular intubation （BCI） in 31 eyes and monocanalicular intubation （MCI） in 35 eyes. Tube removal was planned for 3 months postoperatively, and the patients were followed up for 3 months after the removal of tube. The success rate of canalicular anastomosis and incidence of complications were observed. Results At 3 months after tube removal, 20 cases were cured, 3 cases improved, 8 cases were ineffective in the BCI group, the effective rate was 74.2%. And 27 cases were cured, 8 cases were ineffective in the MCI group, the effective rate was 77. 1%. The difference in the effective rate between the two groups was not statistically significant （X^2= 0. 078, P = 0. 780）. Inferior canalicular slitting postoperative occurred in 8 eyes in the BCI group, 5 eyes of which complicated superior canalicular slitting. No canalicular slitting occurred in the MCI group. The incidence of inferior canalicular slitting in the MCI group was lower than that in the BCI group, the difference between the two groups was statistically signlficant（x^2= 7. 998,P = 0. 005）. Conclusion Both MCI and BCI are effective methods for repairing the inferior canalicular lacerations. MCI has the long-term advantage of lower incidence of canalicular slitting and easy placement.