下泪小管断裂吻合术中内眦韧带减张修复的应用效果

Effects of medial canthus ligament relaxation suture in anastomosis of lacrimal canaliculus laceration

目的探讨外伤性下泪小管断裂吻合术中预置内眦韧带减张缝线的应用效果。方法采用回顾性研究法,收集2014年9月至2016年9月我院眼科收治的32例(32眼)下泪小管断裂合并内眦韧带断裂的病例,找到鼻侧断端后先将内眦韧带断端间预置4-0缝线,确认伤口断端对位满意后,松开预置缝线植入泪道支撑管,8-0可吸收缝线吻合泪小管断端,6-0可吸收缝线缝合皮肤等。术后2~3个月拔管,随访6~12个月,观察泪道通畅情况及溢泪等症状。结果治愈29眼,好转2眼,无效1眼;治愈率达90.62%,有效率达96.88%。术后泪小点撕裂2眼(6.25%),内眦切迹1眼(3.12%)。结论采用减张修复法修复内眦韧带,可以为泪小管断端创造低张力的愈合环境,使泪小管断端对合整齐,效果显著。

Objective To investigate the effects of preset medial canthus ligament relaxation sutures in traumatic inferior canalicular laceration anastomosis.Methods A retrospective study was conducted in 32 patients(32 eyes)with inferior lacrimal canaliculus laceration who admitted to the Department of Ophthalmology from September 2014 to September 2016.In the procedures,after the broken end of the lower lacrimal canaliculus was found,4-0 suture was immediately placed between the ends of medial canthus ligament.After ensuring the satisfaction of the broken ends of the duct,the preset suture was released and the lacrimal stents were implanted.Anastomosis of lacrimal canaliculus laceration was performed with 8-0 absorbable suture,and subcutaneous tissue and skin were sutured with 6-0 absorbable suture.Then the lacrimal stents were removed 2-3 months after the operation.The patients were followed up 6-12 months for analysis of success rate and complications.Results Totally 29 patients were cured,2 patients improved,and 1 patient did not get better,with cure rate of 90.62%and the effective rate of 96.88%.After surgery,lacrimal point tear presented in 2 eyes(6.25%),and notch within medial canthus was found in 1 eye(3.12%).Conclusion Medial canthus ligament relaxation suture can create a low tension healing environment for lacrimal canalicular laceration and improve the cure rate of canalicular laceration anastomosis.