激光泪道成形联合泪道置管术治疗鼻泪管狭窄的疗效观察

Observation on the efficacy of laser lacrimal duct forming combined with lacrimal duct placement for nasolacrimal duct

目的观察行激光泪道成形联合泪道置管术治疗鼻泪管狭窄的临床疗效。方法选取2013年9月—2019年1月在沈阳爱尔眼视光医院就诊的鼻泪管狭窄患者322例(366只眼),随机分为A组167例(197只眼)和B组155例(169只眼)。由同一位医师对2组患者进行手术:A组行Nd:YAG激光泪道成形联合泪道置管术,B组行泪道置管术。术后3个月由手术医师将泪管取出。术前和术后6个月由同一位医师行裂隙灯检查有无泪小点撕裂及息肉增生、泪河宽度检查、荧光染料消失试验和泪道冲洗,并记录数据。结果(1)术后6个月冲洗泪道:A组有效率为90.86%,B组有效率为81.66%,2组比较差异有统计学意义(X^2=6.649,P=0.010);(2)术后6个月的泪溢症状缓解情况:荧光染料消失试验,2组比较有统计学意义(X^2=7.112,P=0.000);泪河宽度检查,2组比较有统计学意义(X^2=6.499,P=0.000);(3)术后6个月并发症情况:A组泪小点撕裂7只眼,息肉增生3只眼,并发症发生率为5.08%,B组泪小点撕裂6只眼,息肉增生7只眼,并发症发生率为7.69%,2组比较,差异无统计学意义(X^2=0.660,P=0.321);(4)术后6个月复发情况:A组泪道再次不通者18只眼,复发率为9.14%,B组泪道再次不通者31只眼,复发率18.34%,2组比较,差异有统计学意义(X^2=5.878,P=0.000)。结论行激光泪道成形联合泪道置管术可有效地治疗鼻泪管狭窄,手术成功率高,手术安全简便,可在临床推广应用。

OBJECTIVE To observe the clinical effect of laser lacrimal ductoplasty combined with lacrimal duct placement in the treatment of nasolacrimal duct stenosis.METHODS A total of 322 patients(366 eyes)with nasolacrimal duct stenosis who were treated at Shenyang Aier Eye Vision Hospital from September 2013 to January 2019 were randomly divided into group A with 167 cases(197 eyes)and group B with 155 cases(169 eyes).Both groups were examined by the same doctor for tear meniscus width examination,fluorescent dye disappearance test,and lacrimal duct flushing,and the results were recorded.Then the same doctor performed surgery for patients in two groups:group A underwent Nd:YAG(Neodymium-doped Yttrium Aluminium Garne)laser dacryocanaliculoplasty combined with lacrimal duct intubation,and group B underwent lacrimal duct intubation.The lacrimal duct was removed by the surgeon 3 months after surgery.Before the surgery,six months after surgery,slit lamp examination was performed for lacrimal punctum tear,hyperplasia polyp and tear meniscus width examination,besides,fluorescent dye disappearance test,and lacrimal drainage were also performed by the same doctor.RESULTS(1)Irrigation of lacrimal duct at the 6th month after operation:the effective rate of group A was 90.86%,and that of group B was 81.66%.The difference between two groups was statistically significant(X^2=6.649,P=0.010);(2)Relief of epiphora at the 6th month after operation:comparison of fluorescence dye disappearance test result between two groups showed statistical difference(X^2=7.112,P=0.000).Comparison of tear meniscus width between two groups showed significant difference(X^2=6.499,P=0.000).(3)Complications at the 6th month after surgery:7 eyes with lacrimal punctum tear and 3 eyes with hyperplasia polyp were found in group A,the incidence of complications was 5.08%.Six eyes with lacrimal punctum tear and 7 eyes with hyperplasia polyp were found in group B.The complication rate was 7.69%.There was no significant difference between the two groups(X^2=0.660,P=0.321).(4)Recurrence at the 6th month after surgery:In group A,18 eyes suffered lacrimal duct obstruction,the recurrence rate was 9.14%;in group B,31 eyes suffered lacrimal duct obstruction,the recurrence rate was 18.34%.The comparison between two groups showed statistically significant(X^2=5.878,P=0.000).CONCLUSIONS Laser dacryocanaliculoplasty combined with lacrimal duct intubation was effective on nasolacrimal duct stenosis.In addition to a high success rate,it was also safe and easy without complications.