硬膜外导管引导并留置硅胶管治疗泪小管断裂

Application of silicone tube guided by epidural anesthesia tubes in canalicular anastomosis

目的:观察硬膜外麻醉导管引导并双路留置硅胶管治疗泪小管断裂的临床效果。方法:收集29眼泪小管断裂的患者,选用带有双引线的泪道引流硅胶软管作为支撑物,通过硬膜外麻醉导管引导,采用双路插管留置硅胶管的方法进行手术治疗,术后予抗感染、冲洗泪道等处理,3个月后拔管,观察术后眼睑外翻、泪小管及泪小点豁裂、眼表异物感、溢泪等情况,评估术后疗效。结果:1例重度眼外伤致下泪小管断裂患者术后出现下睑外翻,半年后行手术治疗,外观及溢泪症状均有改善,疗效视为好转。1例患者拔管后出现泪小管吻合口塌陷闭塞,溢泪,视为无效。其余患者术后均眼睑弧度自然,外观满意,置管期间日常生活不受影响,泪小点及泪小管无豁裂,泪道冲洗通畅,无溢泪,视为治愈。总治愈率93. 1%,好转占3. 4%。结论:结合硬膜外导管及硅胶管两者的优势,留置硅胶管作为泪道支撑物,采用双路置管方法治疗泪小管断裂,可有效提高手术成功率,改善患者术后外观及舒适度。

Objective:To observe the clinical effect of lacerated canalicular anastomosis by indwelling a silicone tube with the bicanalicular intubation method in the guidance of epidural anesthesia tubes.Methods:29 eyes of the patients with lacrimal canalicular laceration were collected.They experienced surgery,some then were given anti-infection and irrigation of lacrimal passage.Annular bicanalicular intubation was used with the help of epidural anesthesia tubes and a silicone tube with double lead as underprop were inserted into impaired lacrimal passage.The silicone tube was pulled out after three months.Clinical data were collected,including ectropion,injury of canaliculi and punctum,foreign body sensation and epiphora.Results:Ectropion was observed on a patient of severe trauma,but his appearance and epiphora subjectively were both improved with correct surgery after six months.The anastomotic stromata of one patient were stopped up and epiphora appeared without further treatment after extubation.All that's left(93.1%of the total)were satisfied with unaffected eyelids and they can study and work in daily life as normal.No eversion of lacrimal punctum was observed or epiphora existed during the follow-up period.Conclusions:The surgical success rate can be improved combining with the advantages of both epidural anesthesia tubes and silicone tube.Patient undergone surgery could achieve better eye comfort and beauty.Materials and methods above are worth of promotion and application in clinical work.