鼻泪管填塞联合黏弹剂注入在复杂泪小管断端定位中的应用

Effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end

目的:探讨鼻泪管填塞联合黏弹剂注入在不易寻找断端的复杂泪小管吻合术中定位鼻侧断端的应用效果。方法:对我院收治13例13眼不易寻找断端的外伤性单根泪小管断裂患者,采用RS泪道引流管自完整的泪小管插入泪道填塞鼻泪管,再注入黏弹剂,使黏弹剂自断裂泪小管的鼻侧断端溢出,用于定位不易寻找鼻侧断端,并完成泪小管吻合手术。结果:不易寻找断端的患眼13眼,使用RS泪道引流管填塞鼻泪管,在注入黏弹剂后,可在显微镜直视下发现凝胶自鼻侧断端溢出,并成功置入泪道引流管,断端寻找成功率为100%。13眼均置管3mo后拔管,随访6mo。其中治愈9眼,显效3眼,无效1眼。治愈率69%,总有效率92%。结论:鼻泪管填塞联合黏弹剂注入操作简单,对术者的临床经验要求相对较低,适合不同程度的单根泪小管断裂患者,能够在较短的时间内完成不易寻找断端的复杂泪小管断裂吻合手术,是一种新的快速定位鼻侧断端的技术。

AIM: To investigate the effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end.METHODS:A total of 13 patients(13 eyes) with traumatic single lacrimal canaliculus rupture were treated in our hospital. RS lacrimal duct drainage tube was inserted into the lacrimal duct from intact lacrimal canaliculus to fill the nasolacrimal duct, then sodium hyaluronate gel was injected to make sodium hyaluronate gel overflow from the nasal broken end of fractured lacrimal canaliculus, which was used to locate the nasal broken end which was difficult to find and completed the lacrimal anastomosis operation.RESULTS: Among the patients with 13 eyes who were difficult to find the broken end, the nasolacrimal duct was filled with RS lacrimal duct drainage tube. After injection of sodium hyaluronate gel, the gel overflowed from the nasal broken end under direct vision of the microscope, and the lacrimal duct drainage tube was successfully inserted, and the success rate of finding the broken end was 100%. Thirteen eyes were extubated after being placed for 3 mo, and then were followed up for 6 mo. Among them, 9 eyes were cured, 3 eyes were markedly effective and 1 eye was ineffective. The cure rate was 69%, and the total effective rate was 92%.CONCLUSION: A new technique for rapid location of nasal broken end is proposed for patients in which are difficult to find the broken end. This method is simple to operate and requires a relatively low clinical experience. It is suitable for patients with different degrees of single lacrimal canaliculus rupture and can complete complex lacrimal canaliculus rupture anastomosis in a short time.