激光泪道成形术治疗阻塞性泪道疾病的疗效观察

The effect of treating obstructive disease of lacrimal passage by lacrimal plastic operation with Nd∶YAG laser

目的 观察掺钕钇铝石榴石激光泪道成形术治疗阻塞性泪道疾病的疗效 ,并对泪道不同阻塞部位的疗效进行分析。方法 采用掺钕钇铝石榴石激光泪道成形术治疗 6 0 3例 (6 93只眼 )阻塞性泪道疾病患者 ,按泪道阻塞的部位分为泪小点阻塞 (2 3只眼 )、泪小 (总 )管阻塞 (192只眼 )、鼻泪管阻塞 (2 2 7只眼 )、慢性泪囊炎 (2 31只眼 )及外伤性泪小管离断 (2 0只眼 ) 5组 ,术后定期冲洗泪道 ,平均随访 1 5年 ,将各组疗效进行对比分析。结果 泪小点阻塞、泪小 (总 )管阻塞、鼻泪管阻塞、慢性泪囊炎及外伤性泪小管离断组的治愈率和有效率分别为 86 9%和 95 7%、89 1%和 93 8%、93 0 %和96 0 %、78 4 %和 82 7%及 4 0 0 %和 6 5 0 %。经Ridit分析 ,各组 R±S R 分别为 0 92 1± 0 0 2 3、0 914±0 0 0 9、0 92 7± 0 0 0 7、0 85 6± 0 0 13及 0 74 9± 0 0 5 5。慢性泪囊炎组疗效低于鼻泪管和泪小 (总 )管阻塞组 (P <0 0 5 ) ;外伤性泪小管离断组疗效低于其他 4组 (P <0 0 5 )。结论 掺钕钇铝石榴石激光泪道成形术治疗鼻泪管阻塞效果最好 ,其他依次为泪点、泪小 (总 )管阻塞、慢性泪囊炎及外伤性泪小管离断 ,但应严格掌握适应证。

Objective To study the therapeutic effects of Nd∶YAG laser on obstructive diseases of the lacrimal passage. Methods 693 eyes in 603 cases with obstructive diseases of lacrmal passage,including obstruction of lacrimal puncta (23 eyes), lacrimal duct (192 eyes), nasolacrimal duct (227 eyes), chronic dacryocystitis (231 eyes), and traumatic laceration of lacrimal canaliculus (20 eyes), were treated by lacrimal plastic operation with Nd∶YAG laster and the therapeutic effects were compared among the groups. Results The cure rates and effective rates of the five diseases were 86.9% and 95.7%, 89.1% and 93.8%, 93.0% and 96.0%, 78.4% and 82.7%, 40.0% and 65.0%, respectively. By Ridit analysis, ±S values for each group were 0.921±0.023,0.914±0.009,0.927±0.007,0.856 ±0.013, 0.749±0.055. Conclusions The therapeutic effect on chronic dacryocystitis is less than those of obstruction of nasolacrimal duct and lacrimal duct ( P <0.05).The therapeutic effect on traumatic laceration of lacrimal canaliculus is less than that of the other four groups ( P <0.05). Therefore,it should be restricted on indication for the cases of chronic dacryocystitis and traumatic laceration of lacrimal canaliculus.