丝线牵引法应用于双路泪道插管术后不同类型硅胶管内眦部脱出的治疗效果

Application of silk thread traction technology in the different types of silicone tube completely dislocate from medial canthus following bicanalicular silicone tube intubation

目的探讨丝线牵引法对双路泪道插管术后不同类型硅胶管内眦部脱出的临床效果。方法对我院眼科收治的12例(12眼)双路泪道插管术后硅胶管内眦部完全脱出(9例)或完全脱出合并硅胶管断裂(3例)的患者采用丝线牵引法复位或取出硅胶管。术后使用左氧氟沙星滴眼液预防患者感染,继续留置硅胶管,每月复诊直至拔管,并检查内眦部硅胶管是否脱出。手术效果判定标准为:将缩至泪囊内的硅胶管牵拉出鼻腔,在硅胶管松弛状态下,硅胶管结稳定在鼻腔内,此时可判定为复位成功;完整取出硅胶管,泪道内无硅胶管残留,可判定取出成功。结果 9例内眦部硅胶管完全脱出患者全部复位,手术成功率为100%。其中3例要求复位后立即取出硅胶管(2例患者因担心硅胶管复位再次脱管,1例患者因角膜鼻侧溃疡灶形成);6例继续留置硅胶管的患者,未出现再次脱出,分别留置3～4个月后拔管。3例内眦部硅胶管完全脱出合并硅胶管断裂的患者顺利取出硅胶管,成功率100%。1例硅胶管复位后即要求拔管的泪总管阻塞患者,在拔管后3周出现再次泪总管阻塞,11例患者在拔管后随访期内未再次出现泪道阻塞。并发角膜溃疡的患者经左氧氟沙星滴眼液治疗1周后痊愈。结论丝线牵引法能够有效应对不同类型的双路泪道插管术后硅胶管内眦部脱出,该方法创伤小,操作简便,成本低廉。

Objective To investigate the effect of silk thread traction in the different types of silicone tube completely dislocate from medial canthus following bicanalicular silicone tube intubation. Methods A total of 12 eyes from 12 patients in our hospital were included,who experienced silicone tube complete dislocation (9 patients) or silicone tube complete dislocation and fracture (3 patients) from medial canthus following the bicanalicular silicone tube intubation underwent retrograde silk thread restore or the remove of the silicone tube.To prevent infection after the surgery,the affected eyes were treated with levofloxacin eye drops.Patients with indwelling tube were examined for the silicone tube position monthly until extubation.Criteria of surgery effect evaluation:Restoration was succeeded when silicone tube was naturally relaxed,and the silicone tube knot was stabilized in the nasal cavity after it was pulled into the nasal cavity from the lacrimal sac.Removal was succeeded when the silicone tube was removed completely without any residual mass left in the lacrimal duct system. Results In all 9 patients of silicone tube complete dislocation,the prolapsed silicone tube was restored with a success rate of 100%,of 3 patients who required extubation immediately after the repositioning (2 patients worried about re-dislocation after the restoration,while 1 patient developed ulcer foci at nasal side of the cornea).For the 6 patients with an indwelling tube,extubation was performed 3 to 4 months after operation;no patient suffered a further dislocation of the tube.In all 3 patients of silicone tube complete dislocation and fracture from medial canthus,the silicone tube was removed with a success rate of 100%.One patient who suffered from obstruction of lacrimal canalidull and who required extubation immediately following restoration,developed obstruction of lacrimal canalidull again at 3 weeks after the extubation,while the remaining 11 patients did not experience obstruction of lacrimal duct within the follow-up period.The patient with corneal ulcer was cured after administration of levofloxacin eye drops for one week. Conclusion The silk thread traction technology for the treatment of different types of silicone tube completely dislocate from medial canthus following bicanalicular silicone tube intubation is effective associated with minor trauma,simple procedure and low cost.