Old canalicular laceration repair:a retrospective study of the curative effects and prognostic factors

AIM： To investigate the epidemiology and surgical outcomes of old canalicular laceration and analyze the variables impacting on the prognosis of reparation. METHODS： A retrospective review of all old canalicular laceration repairs from Jan. 1, 2008 to Dec. 30, 2015 was performed. Analyzed data included demographics, mechanisms of injury, the time from injury to repair, causes for delayed repair, old associated injuries, the types of surgery, and the effects of repair using canaliculus anastomosis combined with bicanalicular stent intubation. RESULTS： Totally 148 patients with old canalicular laceration received surgical repair and were enrolled. The mean age at presentation was 32.52 years old （ranged from 3 to 63 years old）. The 110 patients （74.32%） were male and 127 patients （85.81%） were adults （__.18 years old）. The old upper, lower, and bicanalicular lacerations were found in 5 （3.38%）, 39 （26.35%）, and 104 patients （70.27%）, respectively. The mechanism of old injury was primarily due to motor vehicle accidents （n=53, 35.81%）. The mean time from injury to repair was 43.61mo （ranged from 1 to 360mo）. Associated old ocular and orbit injuries were found in 65 patients （43.92%）, and chronic dacryocystitis in 18 patients （12.16%）. The main cause of delayed repair was that doctors or patients didn＇t pay attention to the canalicular laceration because of the concurrent severe injuries （n=71, 47.97%）. Totally 136 patients （91.89%） with old canalicular laceration underwent canaliculus anastomosis combined with bicanalicular stent intubation. In all of them, 20 patients （13.51%） were combined with dacryocystorhinostomy. In these cases, 132 patients （97.06%） attained anatomic success, 121 patients （88.97%）reported no epiphora （functional success）, 11 patients （8.09%） reported significant epiphora anesis （functional improvement）, and 4 （2.94%） reported no significant anesis （functional failure）. Rates of anatomic success and functional success were significantly correlated with different canaliculus involved. However, rates of anatomic success and functional success were not significantly affected by the time from injury to repair. CONCLUSION： The canalicular anastomosis combined with bicanalicular stent intubation could act as an effective therapeutics for old canalicular laceration.

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.

Use of Silicone Tubes to Repair Canalicular Lacerations via a Novel Method

Purpose:To develop a novel method to repair canalicular lacerations using silicone tubes.Methods:A total of 47 adult patients(47 eyes)with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012.The age ranged from16 to 53 years.Among the 47 eyes,37 had lower canalicular lacerations,6 had upper canalicular lacerations,and 4 had bicanalicular lacerations..A soft probe was made using a stainless steel acupuncture needle,which was inserted into the lumen of the proximal part of the catheter to increase its rigidity.The probe was then inserted into the lacrimal sac and nasolacrimal duct.After retrieval of the catheters,the two ends of the silicone tube were securely tied.(end to end).to the catheters..The silicon tube outside the nostril formed a Ushape.The catheters were then pulled upward until the silicone tube was completely located in the canalicular system.The catheters were cut off of the silicone tube near the site of the connection.The two ends of the silicone tube were cut short,~2mm out of the lacrimal punctum,and tied securely,end to end.The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus,and the suture was removed through the nostril.The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).Results:.All cases were anatomically rehabilitated after surgery..The silicone tube was removed after implanted in 3-10months (mean 4.5±1.3 months),the average follow-up time was 11.8 months after removal.In total,45 eyes in all 47eyes (95.74%)were free from obstruction.Among them,41eyes (91.11%) achieved complete success(completely disap-pearance of epiphora after tube removal),.4 eyes.(8.89%)achieved partial success.(irritation occurs under stimulation conditions,such as wind or cold conditions),4 eyes showed postoperative tearing,with three eyes having inferior lacrimal duct laceration,and one eye with superior canalicular laceration.Apart from two cases (4.26%) suffering inferior punctum splitting,no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.Conclusion:For adult patients with canalicular laceration,the NCI was an effective,atraumatic surgery,which has fewer complications than traditional canalicular suture.

“经皮肤一针吻合法”修复泪小管断裂的临床研究(英文)

目的:探讨经皮肤"一针吻合法"修复泪小管断裂手术的安全性和有效性。方法:回顾性分析32例(32眼)采用"经皮肤一针吻合法"修复的泪小管断裂病例资料,下泪小管断裂29例,上泪小管断裂1例,上下泪小管同时断裂2例。手术均在手术显微镜下进行,用5-0丝线缝合,用直径为0.8mm硅胶管作为泪管支架插入吻合的泪小管,术后3mo拔除泪管支架,随访时间3～36mo。结果:32例病例中,治愈28例(88%),基本治愈3例(9%),无效1例(3%)。拔除支架管后,29例患者随访1～36(平均12)mo,3例患者失随访。所有病例眼睑伤口愈合良好,无眼睑和内眦外伤性畸形。结论:"经皮肤一针吻合法"法修复泪小管断裂,能直接吻合泪小管的两断端,伤口不长期存留缝线,避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。这种方法简化了手术操作,减少了手术损伤,是经济、安全、有效的。

“经皮肤一针吻合法”修复泪小管断裂的临床研究

目的探讨“经皮肤一针吻合法”修复泪小管断裂手术的安全性和有效性。方法回顾性分析32例（32眼）采用“经皮肤一针吻合法”修复的泪小管断裂。下泪小管断裂29例，上泪小管断裂1例，上下泪小管同时断裂2例。手术均在手术显微镜下进行，用5-0丝线缝合，用硬膜外麻醉导管（直径0．8mm）作为泪管支架，术后3个月拔除硬膜外麻醉导管支架。结果32例中，治愈28例（87．50％），基本治愈3例（9．38％），无效1例（3．12％）。拔除支架管后，29例随访1—36个月（平均12个月），3例失随访。所有病例眼睑伤口愈合良好。无眼睑和内眦外伤性畸形。结论“经皮肤一针吻合法”修复泪小管断裂，能直接吻合泪小管的两断段，伤口不长期存留缝线，避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。

影响泪小管断裂吻合修复的原因分析

目的 探讨外伤性泪小管断裂吻合手术的方法和影响手术成功的因素。方法 就 3 3例下泪小管断裂吻合修复术的经验 ,分析影响手术成功的因素及对策。结果 本组成功率为 81 8% ,发现了 6例失败的病例与不利因素的关系。结论 外伤性泪小管断裂行正确的修复手术有助于提高手术成功率。

RS泪道引流管与单腔硅胶泪道引流管在泪小管损伤修复中的应用比较

目的:探讨RS泪道引流管与单腔硅胶泪道引流管在泪小管损伤修复中的临床疗效。方法:选择下泪小管断裂病人38例,按泪道支撑物种类不同分为观察组和对照组。观察组泪道支撑物为RS泪道引流管,对照组泪道支撑物为单腔硅胶泪道引流管。对比2组病人手术时间、术后并发症、临床疗效差异。结果:观察组病人手术时间为(45.17±5.80)min,显著短于对照组的(57.07±5.09)min(P<0.01)。观察组病人术后鼻出血1例,泪点撕裂1例;对照组病人出现眼睑外翻1例,置管脱落2例,泪点撕裂3例;2组病人术后并发症总发生率对比差异有统计学意义(P<0.05)。拔管后随访3个月,2组病人术后效果差异无统计学意义(P>0.05)。结论:RS泪道引流管对于泪小管损伤修复有良好的手术效果,与单腔硅胶泪道引流管相比,手术时间更短,术后并发症更少,值得临床推广应用。

外伤性泪小管断裂泪道置管修复术43例疗效分析

目的：探讨在显微镜下行急诊泪小管断裂泪道置管修复术的疗效。方法：回顾性分析43例急诊外伤性泪小管断裂患者,在显微镜下寻找泪小管鼻侧断端、植入硬膜外麻醉导管、吻合修复泪小管。术后随访统计分析。结果：43例患者手术经过3~12个月随访,裂伤眼睑获得解剖复位,无流泪现象、冲洗泪道通畅39例（90.70%）,冲洗不通者4例（9.30%）。结论：急诊行一期吻合术,在显微镜下找到鼻侧泪小管断端、支撑物的植入和固定是手术成功的关键。

外伤性下泪小管断裂吻合31例临床分析

目的探讨外伤性泪小管断裂的手术治疗方法。方法利用硬膜外麻醉导管手术治疗外伤性下泪小管断裂共31例,均行Ⅰ期吻合,术后随访6～18个月。结果术后3个月拔管,冲洗泪道通畅,治愈率100％。结论外伤性泪小管断裂Ⅰ期吻合联合硬膜外麻醉导管插管是一种简便易行又有效的手术方法。

外伤性泪小管断裂吻合术的临床护理体会

目的观察外伤性泪小管断裂吻合术在泪小管功能恢复中的临床效果并总结护理经验。方法对41例在我院就诊的外伤性泪小管断裂患者进行吻合术修复,分析临床护理资料,观测并发症发生及泪小管再通情况。结果 41例患者均顺利完成外伤性泪小管断裂吻合术,未出现术后伤口感染、导管脱落、泪小点撕裂及眼睑外翻等手术并发症。泪小管再通功能恢复总有效率达97.6%,痊愈率达75.6%。结论外伤性泪小管断裂吻合术应用效果良好,通过合理的护理方法避免了并发症的发生,实现了泪小管再通功能,患者溢泪症状得到明显改善。

密质骨弥散性微损伤非骨重建自修复

弥散性微损伤是骨疲劳引发的主要骨微损伤之一。骨损伤修复普遍认为完全通过骨重建过程完成。研究发现与线性裂痕不同,弥散性微损伤的骨细胞未凋亡,损伤区在"无骨重建过程"下进行了直接修复。基于此新发现,本文对弥散性基质微损伤的特殊自修复相关机制研究进行综述,旨在为骨微损伤修复研究提供一个新视角,并为临床治疗骨组织疾病提供新思路。

下泪小管断裂吻合术中内眦韧带减张修复的应用效果

目的探讨外伤性下泪小管断裂吻合术中预置内眦韧带减张缝线的应用效果。方法采用回顾性研究法,收集2014年9月至2016年9月我院眼科收治的32例(32眼)下泪小管断裂合并内眦韧带断裂的病例,找到鼻侧断端后先将内眦韧带断端间预置4-0缝线,确认伤口断端对位满意后,松开预置缝线植入泪道支撑管,8-0可吸收缝线吻合泪小管断端,6-0可吸收缝线缝合皮肤等。术后2~3个月拔管,随访6~12个月,观察泪道通畅情况及溢泪等症状。结果治愈29眼,好转2眼,无效1眼;治愈率达90.62%,有效率达96.88%。术后泪小点撕裂2眼(6.25%),内眦切迹1眼(3.12%)。结论采用减张修复法修复内眦韧带,可以为泪小管断端创造低张力的愈合环境,使泪小管断端对合整齐,效果显著。

双泪小管置管法修复泪小管断裂的临床应用

目的探讨应用硬膜外导管行双泪小管置管法修复泪小管断裂手术的安全性和有效性。方法回顾性分析42例（42眼）采用硬膜外导管行双泪小管置管法修复泪小管断裂的病例资料，下泪小管断裂38例，上下泪小管断裂4例。手术均在手术显微镜下进行，用硬膜外导管（直径0．6—0．8mm）作为泪管支架，从下泪点穿人从颞侧断裂口穿出，再从鼻侧断裂口穿入，经泪总管至鼻泪管。用8—0丝线吻合泪小管两断端2针，结节缝合结膜，肌层和皮肤。将硬膜外导管外露端反插入上泪点至泪囊。结果42例中，治愈36例，基本治愈4例，无效2例。拨除硬膜外导管后，42例随访2～6个月。所有病例术后眼睑伤口愈合良好，泪点位置正且无裂伤，无眼睑或内眦外伤性畸形。结论双泪小管置管法修复泪小管断裂，对泪道损伤小且支撑管隐蔽不影响患者外观，同时还克服了冬季导管外露的弊端。在上下泪小管断裂伤病例，可用一根支撑管吻合上下泪小管。

Worst泪道探针法治疗泪小管断裂临床效果分析

目的:观察比较worst泪道探针法与双路泪道插管法在泪小管断裂修复术中的临床效果。方法:59例泪小管断裂吻合术中,36例采用双路泪道插管法,23例采用worst泪道探针法环形置管,观察术后不同阶段临床效果。结果:术后观察早期吻合口豁裂者:双路组3例(8.33%),worst泪道探针组2例(8.69%),两组差异无显著意义(x2=0.002,P>0.05);硅胶管留置期间罹患泪小管炎者:双路组9例(25.00%),worst泪道探针组1例(4.35%),两组差异有显著意义(x2=4.261,P<0.05);术后6个月拔管泪道冲洗通畅者:双路组32例(88.89%),worst泪道探针组20例(86.96%),两组差异无显著意义(x2=0.050,P>0.05)。结论:泪小管断裂吻合术中,worst泪道探针法操作简便,留置期间稳定性佳,并发症少,治疗效果好,是一种理想的手术方式。

经皮肤一针吻合并双泪小管置管法修复上下泪小管同时断裂

目的探讨“经皮肤一针吻合并双泪小管置管法”修复上下泪小管同时断裂的手术的效果。方法回顾性分析11例（11眼）采用“经皮肤一针吻合并双泪小管置管法”修复的上下泪小管同时断裂病例的资料。手术显微镜下分别找到上下泪小管的颞侧和鼻侧断端，用直径为0．8mm硅胶管作为支架插入拟吻合的泪小管，用5—0丝线分别经皮肤吻合上、下泪小管断端各1针。术后3个月拔除泪小管支架，随访时间3—36个月。结果11例中，治愈9例，基本治愈1例，无效1例。所有病例眼睑伤口愈合良好，无眼睑或内眦外伤性畸形。无并发泪点撕裂者，无自行意外拔出硅胶管者。结论本手术能直接同时吻合断裂的上下泪小管，且硅胶管隐蔽。伤口无长期存留缝线，避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。

泪小管断裂修复术失败原因分析及处理方法

目的分析泪小管断裂修复术失败的常见原因以及探讨正确的处理方法。方法就31例下泪小管断裂修复术的经验，分析影响手术成功的因素及为减少术后并发症术中如何正确处理。结果本组治愈率为83．87％，5例手术失败，并找到手术失败的原因。结论外伤性泪小管断裂行正确的修复手段，不仅可以缩短手术时间，而且更可以提高手术成功率。

下泪小管深部断裂快速吻合78例经验总结

目的总结经上泪小管探针辅助法用于下泪小管深部断裂快速吻合的可行性。方法2015年11月至2016年11月收治的78例（78只眼）下泪小管深部断裂患者，经上泪小管探针辅助下行下泪小管深部断裂吻合手术，术中定位下泪小管鼻侧断端时间均短于5min，总手术时间约30-60min。3个月左右拔除泪道引流管，随访6-12个月，常规冲洗泪道，评估手术成功率、并发症等。结果78例患者术中均较快找到下泪小管鼻侧断端并成功吻合。其中75例治愈（患者无溢泪，泪道冲洗通畅）；3例好转（患者偶发溢泪，冲洗泪道通而不畅）；总有效率100％。结论上泪小管探针辅助法可应用于下泪小管深部断裂吻合，手术时间短，成功率高，术后效果好，并发症少，值得推广。