双路环形置入硅胶管吻合法联合“Z”字皮瓣修复术治疗泪小管裂伤

Observation of double loop insertion of silicone rubber tube anastomosis method combined with "Z" flap repair in the treatment of lacrimal ductule laceration

目的:探讨双路环形置入硅胶管联合"Z"字皮瓣修复术在治疗眼睑裂伤伴泪小管断裂伤中的临床疗效。方法:回顾2014-01/2016-01期间我院收治的外伤原因导致的眼睑裂伤伴泪小管断裂伤45例。在泪小管吻合及眼睑裂伤缝合术中,分别采取单路置入腰麻管对位皮肤缝合或双路环形置入硅胶管联合"Z"字皮瓣修复术的方法。比较两种方法术后发生眼睑内外翻、泪小点外翻、眼睑瘢痕、吻合口二次裂开等并发症的机会。结果:选择单路置入腰麻管对位皮肤缝合术的患者22例中21例拔管后行泪道冲洗结果通畅,吻合成功。1例吻合失败。其中20例不同程度出现并发症并对外观影响较大。选择双路环形置入硅胶管联合"Z"字皮瓣修复术患者23例中,23例拔管后行泪道冲洗结果通畅或基本通畅,均吻合成功。其中2例出现眼睑轻度内翻,泪小点内翻。眼睑严重畸形及创口再次撕裂均未出现,瘢痕挛缩不明显。两者吻合成功率方面比较,利用Fisher确切概率法,差异无统计学意义(P=0.4889)。两者出现并发症方面比较,差异有统计学意义(χ~2=30.42,P<0.05)。结论:双路环形置入硅胶管联合"Z"字皮瓣修复术治疗眼睑裂伤合并泪小管断裂,在有效地保证泪小管吻合成功率的同时,最大限度地改善了眼部外观,减少了术后并发症的发生。

AIM：To investigate the clinical curative effect of double loop insertion of silicone rubber tube combined with ＂ Z＂ flap repair in the treatment of laceration of eyelid with canaliculus laceration.METHODS：The paper reviewed 45 cases of laceration of eyelid with laceration canaliculus,caused by trauma,which were treated in my hospital from January 2014 to January 2016.In the process of anastomosis of lacrimal duct and suture of eyelid laceration,either the method of single spinal anesthesia tube placement on skin contraposition suture or the method of dual annular silicone tube placement combined with the word ＂ Z＂ flap repair was used.We compared the two methods and studied the possible complications like eyelid varus and valgus,lacrimal point valgus,eyelid scar,anastomotic dehiscence again.RESULTS：Out of the 22 cases in which the patients chose the single spinal anesthesia tube implantation on skin suture,21 cases succeeded and patients received lacrimal duct patency results after extubation;and 1 case anastomosis failed.Complications：20 cases had different degree of complications and the impact on their appearances were significant.Out of the 23 cases in which the patients chose double passage annular silicone tube joint prosthesis implantation Z flap,23 received extubation results lacrimal patency or almost patency,the anastomosis of patients was successful.Complications：in two cases,patients had mild eyelid entropion and pomatum varus.Both eyelid deformity and severe wound tear did not occur in all cases again.Scar was not obvious.The success rate of anastomosis between the two groups was not significantly different（P=0.4889）.To compare the rate of complications,there were significant differences（χ~2=30.42,P0.05）.CONCLUSION：The application of dual ring implantation silicon tube combined with the word ＂ Z＂ flap repair in the treatment of lacrimal canaliculi laceration of eyelid laceration ensured the success rate of lacrimal canalicular anastomosis,greatly improved the eye appearances,and reduced the incidence of postoperative complications.