丝裂霉素C联合高频治疗仪并双路环形泪道引流在上泪道阻塞中的应用

Application of mitomycin C combined with high-frequency treatment instrument and dual-channel circular lacrimal duct drainage in upper lacrimal duct obstruction

目的探究丝裂霉素C (MMC)联合高频治疗仪并双路环形泪道引流在上泪道阻塞中应用价值。方法选择2017年7月至2019年7月于武安市第一人民医院治疗的82例(86只眼)上泪道阻塞患者,其中男性40例,女性42例;年龄20~60岁,平均年龄38.75岁。随机分为对照组(41例43只眼)和观察组(41例43只眼)。对照组采用高频治疗仪并双路环形泪道引流治疗,观察组采用MMC联合高频治疗仪并双路环形泪道引流治疗。比较两组患者的临床疗效;比较两组患者的手术时间、住院时间及术后拔管时间;比较两组患者治疗前后的眼表改变评分、泪膜破裂时间、眼泪P物质(SP)含量和泪液弯液面水平;比较两组患者术后并发症发生情况;Kaplan-Meier法绘制生存曲线,比较两组患者术后1年内未复发率。结果对照组与观察组治疗前的眼表改变评分[(32.21±2.52)分vs (32.45±2.61)分]、泪膜破裂时间[(8.35±0.76) s vs (8.38±0.80) s]、眼泪SP含量[(348.75±18.58) pg/mL vs (356.64±17.66) pg/mL]、泪液弯液面水平[(0.63±0.18) mm vs (0.65±0.20) mm]及术后并发症发生率(25.58%vs 13.95%)差异无统计学意义(P> 0.05);两组患者治疗后的眼表改变评分[(29.12±1.83)分vs (26.06±1.55)分]、眼泪SP含量[(295.47±15.31) pg/mL vs (258.72±12.49) pg/mL]、泪液弯液面水平[(0.46±0.16) mm vs (0.25±0.15) mm]明显降低,泪膜破裂时间[(8.87±0.85) s vs (9.60±0.88) s]明显增加(P <0.05),观察组各指标的改善情况明显优于对照组(P <0.05);观察组治疗后的住院时间[(4.15±2.21) d]、术后拔管时间[(4.06±1.07)个月]明显短于对照组[(6.05±2.18) d、(4.65±1.28)个月],治疗总有效率(81.40%)和未复发率(81.40%)明显高于对照组(51.16%、58.14%)(P <0.05)。结论 MMC联合高频治疗仪并双路环形泪道引流治疗上泪道阻塞能够明显提高患者治疗的总有效率,促进患者恢复,降低患者术后复发率。

Objective To explore the application value of mitomycin C(MMC) combined with high-frequency treatment instrument and dual-channel circular lacrimal duct drainage in upper lacrimal duct obstruction. Method From July 2017 to July2019, 82 patients(86 eyes) with upper lacrimal duct obstruction were enrolled, which included 40 males and 42 females, aged20-60 years old with mean age of 38.75 years old. All of them were randomly divided into control group(n = 41, 43 eyes)and observation group(n = 41, 43 eyes). The control group performed high-frequency treatment device and dual-channel circular lacrimal duct drainage, and observation group performed MMC combined with high-frequency treatment device and du-al-channel circular lacrimal duct drainage. The clinical efficacy, operation time, hospitalization time and postoperative extuba-tion time between 2 groups were compared;the scores of ocular surface changes, lacrimal film rupture time, tear substance P(SP) content and tear meniscus level before and after treatment between 2 groups were compared;postoperative complications between 2 groups were compared. The Kaplan-Meier method was used to draw survival curve, and non-recurrence rate within1-year after operation between 2 groups were compared. Result Before treatment,there was no statistically significant difference between control group and observation group in scores of ocular surface changes[(32.21 ± 2.52) scores vs(32.45 ± 2.61)scores], lacrimal film breakup time[(8.35 ± 0.76) seconds vs(8.38 ± 0.80) seconds], tear SP content[(348.75 ± 18.58) pg/mL vs(356.64 ± 17.66) pg/mL], tear meniscus level[(0.63 ± 0.18) mm vs(0.65 ± 0.20) mm] and postoperative complication rate(25.58 %vs 13.95 %)(P > 0.05);After treatment, compared with control group, the scores of ocular surface changes[(29.12 ± 1.83) scores vs(26.06 ± 1.55) scores], tear SP content[(295.47 ± 15.31) pg/mL vs(258.72 ± 12.49) pg/mL], tear meniscus level[(0.46 ±0.16) mm vs(0.25 ± 0.15) mm] were significantly reduced, and lacrimal film breakup time[(8.87 ± 0.85) seconds vs(9.60 ±0.88) seconds] was significantly increased(P < 0.05) in observation group. The improvement of each index in observation group was significantly better than that in control group(P < 0.05);The hospitalization time post treatment[(4.15 ± 2.21) days] and postoperative extubation time[(4.06 ± 1.07) months] of observation group were significantly shorter than those of control group[(6.05 ± 2.18) days,(4.65 ± 1.28) months]. The total effective rate of treatment(81.40 %) and non-recurrence rate(81.40 %)in observation group were significantly higher than those in control group(51.16 %, 58.14 %)(P < 0.05). Conclusion It is demonstrated that MMC combined with high-frequency treatment instrument and dual circular lacrimal duct drainage in upper lacrimal duct obstruction could significantly improve the total effective rate of treatment, promote recovery and reduce post-operative recurrence rate of patients.