泪道支架术后再次梗阻280眼原因探析

Cause of the lacrimal duct obstruction reoccured after lacrimal duct stent operation

目的:探讨泪道支架术后再次梗阻原因。方法:对泪道支架患者523例523眼,术前检查眼部鼻腔相关情况,观察泪道阻塞与相关疾病关系,泪道支架术后平均随访2a。其中280眼再次梗阻,观察分析再次梗阻原因。结果:泪道阻塞往往继发于结膜或鼻腔黏膜的炎症蔓延。高位阻塞与慢性结膜炎关系密切,低位阻塞与下鼻甲肥大关系更密切。两种支架拔除后再次阻塞都是其失败的首要原因。环形支架术后发生低位梗阻为其再次梗阻的第二位因素。而球头型支架再梗阻第二位因素为术后继发高位泪道阻塞。结论:泪道支架手术安全、简单,门诊治疗方便,但随植入支架时间延长疗效逐年减低。应根据泪道阻塞患者的可能病因、泪道阻塞部位、年龄、治疗情况,制定个性的综合治疗方案。

AIM： To discuss the cause of lacrimal duct obstruction relapsed after lacrimal duct stent operation. METHODS： A total of 523 patients（523 eyes）of lacrimal duct obstruction were enrolled. They were given regular examination of the eyes and nose before lacrimal duct stent operation. We analyzed the correlation between the lacrimal duct obstruction and the relevant disease. And 280 cases reoccurred lacrimal duct obstruction during the average 2a follow-up. The causes correlated with the relapsed obstruction were assessed. RESULTS： Lacrimal duct obstruction mostly occurred secondary to the inflammation of conjunctiva or nasal mucosa. The upper site obstruction correlated with the chronic conjunctivitis, while the lower site obstruction related to the hypertrophy of inferior turbinate. Outcome of some cases were discouraging after the stents removed. The removal of the ring silicone tube usually leaded to the upper site obstruction, while the lower site obstruction usually caused by the removal of spherical silicone tube.CONCLUSION： Lacrimal duct stent operation is a simple, safe and outpatient treatment. But the long-term effectiveness is not encouraging. We should make personal treatment according to the etiological factor, the site of the obstruction, age, and the procedure of treatment.