对比泪道硅胶引流管A型和A1型治疗慢性泪囊炎的临床疗效

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

目的对比分析两种不同类型泪道硅胶引流管A型和A1型对慢性泪囊炎患者临床疗效的影响。方法回顾分析2014年3月至2016年1月在商丘市第一人民医院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696例（763只眼），根据术中置入泪道硅胶引流管型号不同分为两组，A组术中置入泪道硅胶引流管A型314只眼，A1组术中置人泪道硅胶引流管A1型449只眼，两组患者术后均留置3个月拔管，拔管后随访3个月，观察并对比两组患者术中首次拉管到位率、手术时间、术后泪道通畅情况及并发症发生率。结果拔管后3个月，A组治愈114只眼，好转74只眼，无效126只眼，有效率59．87％；A1组术后治愈209只眼，好转96只眼，无效144只眼，有效率67．93％，两组间有效率比较差异有统计学意义（P=0．022）；术中A组首次拉管到位61只眼，A1组153只眼，两组问差异有显著统计学意义（P〈0．01）；A组患者平均手术时间为13．5min，A1组9．7min，两组问差异有显著统计学意义（P〈0．01）。术后A1组拔管时23只眼出现拔管困难，A组32只眼出现拔管困难，A组拔管困难发生率明显高于A1组，差异有显著统计学意义（P=0．008）。结论泪道硅胶引流管A1型治疗慢性泪囊炎较A型能够提高首次拉管到位率，缩短手术时间，减少了硅胶引流管对泪道黏膜的损伤，提高了手术成功率，且拔管困难发生率明显低于A型，所以A1型对慢性泪囊炎患者的治疗效果优于A型。

Objective To compare the clinic effectiveness of silicone intubation for treating chronic dacryocystitis with different type silicone stents. Methods In a retrospective, nonrandomized comparative case series,from March 2014 to Janurary 2016,696 cases （ 763 eyes ） with chronic dac- ryocystitis were divided into type A silicone stent group （314 eyes） and type A1 silicone stent group group （449 eyes） depending on the type of silicone stent. And the patients were followed up for 3 months after the removal of tubes.The patency of lacrimal duct, the rate of stent drawn in the cor- rect position for the first time, operation time and incidence of complications were observed. Re- suits After 3 months of postextubation, 114 eyes were cured, 74 eyes were improved,126 eyes were failed,the overall successful rate was 59.87% in type A silicone stent group.And 209 eyes were cured, 96 eyes were improved,144 eyes were failed,the overall successful rate was 67.93% in type A1 silicone stent group. The difference between two groups had statistically significance （P =0.022）. the stents were drawn in the correct position firstly in 61 eyes in type A silicone stent group, and 153 eyes in type AI silicone stent group. The difference between two groups had statistically significance（P 〈0.01）.The mean operation time was 13.5min in type A silicone stent group,and 9.7min in type A l silicone stent group. The difference between two groups were statistically significant （P 〈 0.01）. Failure of extubation was observed in 32 eyes in type A silicone stent group and 23 eyes in type A1 silicone stent group. The incidence of extubation failure in type A1 silicone stent group was lower than that in type A silicone stent group with statistically significance （P=0.008）. Conclusion Type A1 Silicone stents in the treatment of chronic dacryocystitis were much easier drawn in the correct position firstly than type A silicone stent. They can also shorten operation time, reduce the injury to lacrimal duct mucosa, so that can improve the success rate of surgery. And the incidence of extubation failure was significantly lower than that of type A silicone stent. So that the ef- ficacy of type Al silicone stent in treatment of chronic dacryocystitis was better than that of type A silicone stent.