两种新型断裂泪小管吻合装置手术方式的疗效比较

Clinical observation of two surgical methods based on a new type of lacrimal canalicular anastomosis device

目的:评估基于新型断裂泪小管吻合装置的两种手术方式的临床效果。方法:本研究选择下泪小管断裂病例80例80眼,以新型泪小管吻合装置的两种探针行泪小管吻合术,其中观察组以弹性猪尾探针行双泪道置管,对照组以直探针行单泪道置管,评估两种术式的术中及术后的相关临床疗效指标。结果:观察组平均置管时间和平均手术时间为12.1±3.7、28.9±5.6min,对照组为21.2±5.5、34.4±6.8min(t=8.68、3.95,均P<0.05)。术后3mo时观察组的泪道解剖成功和功能成功为40眼(100%)和38眼(95%),对照组为40眼(100%)和39眼(98%);术后12mo时观察组为35眼(88%)和36眼(90%),对照组为33眼(82%)和36眼(90%)(P>0.05)。术后观察组有4例泪溢和5例泪道狭窄,对照组有4例泪溢、7例泪道狭窄、5例皮肤瘢痕、2例置管移位和1例眼睑松弛(P>0.05)。两组术中的泪道探通率均为100%,且无假道形成。结论:采用弹性猪尾探针行双泪道置管和直探针行单泪道置管治疗泪小管断裂各有优势,均为临床有效可行的治疗方法。

AIM:To evaluate the clinical effect of two surgical methods based on a newtype of lacrimal canalicular anastomosis device.METHODS:In this research, we observed eighty relative cases(80 eyes) of traumatic lower canalicular laceration and all clinical assessments were performed during and after operation. Two kinds of probes were used for lacrimal canalicular anastomosis. The elastic pigtail probe was used for double lacrimal canalicular intubation(experience group) and the straight probe was used for single lacrimal canalicular intubation(control group).RESULTS: The average time of intubation was 12.1±3.7 min in experience group and 21.2±5.5 min in control group(t=8.68, P<0.05), and the average time of total operations was 28.9±5.6 min in experience group and 34.4±6.8 min in control group(t=3.95, P<0.05). The rates of anatomic and functional success were 88%(35 cases) and 90%(36 cases) in experience group and 82%(33 cases) and 90%(36 cases) in control group at 12 mo after operation(P>0.05). There were 4 cases of epiphora and 5 cases of lacrimal stenosis in the experience group, and 4 cases of epiphora, 7 cases of lacrimal stenosis, 5 cases of skin scar, 2 cases of catheter displacement and 1 case of eyelid relaxation in the control group(P>0.05). The intraoperative penetration rate was 100% in both groups, and the false path was not observed in this study.CONCLUSION: The two methods of lacrimal canalicular anastomosis have different advantages, and they are both effective and feasible therapies in clinic.