泪道硅胶引流管留置时间对慢性泪囊炎患者疗效的影响

Compare the clinical effectiveness of silicone intubation for treating chronic dacryocystitis with different intubation time

目的对比分析泪道硅胶引流管逆行植入术引流管两种不同留置时间对慢性泪囊炎患者临床疗效的影响。方法临床病例对照研究。回顾分析自2012年1月至2015年9月在商丘市第一人民医院眼科采用泪道硅胶引流管逆行植入术治疗的慢性泪囊炎患者，共105例（120只眼），根据术后泪道硅胶引流管留置时间不同分为两组，泪道硅胶引流管留置6周组60只眼，泪道硅胶引流管留置12周60只眼，两组患者拔管后随访3个月，观察并对比两组患者泪道通畅情况、溢泪症状及并发症发生率。结果拔管后3个月，泪道硅胶引流管留置6周组治愈20只眼，好转14只眼，无效26只眼，有效率56．7％；泪道硅胶引流管留置12周组术后治愈16只眼，好转9只眼，无效35只眼，有效率41．7％，两组间有效率比较差异无统计学意义（P=0．1）。拔管当日，泪道硅胶引流管留置6周组治愈42只眼，好转15只眼，无效3只眼；留置12周组术后治愈32只眼，好转17只眼，无效11只眼，两组间有效率比较差异有统计学意义（P=0．023）。术后泪道硅胶引流管留置6周组拔管时2只眼出现拔管困难，引流管留置12周组14只眼出现拔管困难，发生率明显高于留置6周组，差异显著有统计学意义（P=0．001）。结论泪道硅胶引流管留置6周和12周治疗慢性泪囊炎有效率无明显差别，但随着硅胶管留置时间延长，患者泪道冲洗通畅率下降，且增加了拔管困难，泪道硅胶管术后留置6周拔管更值得临床应用。

Objective To compare the clinic effectiveness of silicone intubation for treating chronic dacryocystitis with different intubation time after surgery. Methods In a retrospective, nonran- domized comparative case series, from January 2012 to September 2015, 105 patients （120 eyes） with chronic dacryocystitis were divided into silicone intubation 6 weeks group （60 eyes） and sili- cone intubation 12 weeks group （60 eyes） depending on silicone stent intubation time. And the pa- tients were followed up for 3 months after the removal of tubes. The patency of lacrimal duct, dis- appearance of the symptoms and incidence of complications were observed. Results After 3 months of postextubation, 20 eyes were cured, 14 eyes were improved, 26 eyes were failed, the overall sue- cessful rate was 56.7% in silicone intubation 6 weeks group. And 16 eyes were cured, 9 eyes were improved, 35 eyes were failed, the overall successful rate was 41.7% in silicone intubation 12 weeks group. The difference between two groups had no statistically significance （P =0.1）. On the day of exbution, 42 eyes were cured, 15 eyes were improved, 3 eyes were failed in silicone intuba- tion 6 weeks group. And 32 eyes were cured, 17 eyes were improved, 11 eyes were failed in sili-cone intubation 12 weeks group. The difference between tyro groups were statistically significant （P = 0.023）. Failure of extubation was observed in 2 eyes in silicone intubation 6 weeks group and 14 eyes in silicone intubation 12 weeks group. The incidence of extubation failure in silicone intubation 6 weeks group was lower than that in silicone intubation 12 weeks group with statistically signifi- cance （P =0.001）. Conclusions The effective rate are similar between two groups, but with the sili- cone inmbation time extending the patency of lacrimal duct decline, and incidence of extubation fail- ure increases. So that silicone 5tent intubating in lacrimal duct for 6 weeks before extubation is worth promoting application.