新型逆行泪道置管术治疗泪道阻塞性疾病临床治疗效果及经验体会

发布时间：2018-10-08 16:43

【摘要】：目的:本研究旨在探讨分析采用新型逆行泪道置管术治疗泪道阻塞性疾病的临床治疗效果及经验体会。方法:收集2012年3月至2016年6月于大连医科大学附属第一医院三部眼科确诊为泪道阻塞的患者72例77眼,年龄31～76岁,中位年龄56岁,病程为6个月～20年,中位病程48月,其中男性患者19例20眼,女性患者53例57眼,男:女=1:2.74,单独右眼患病28例,单独左眼患病39例,双眼患病5例。包括单纯下泪小管阻塞患者6例7眼(并发泪小管结石1眼);单纯泪总管阻塞患者10例11眼;鼻泪管阻塞患者39例41眼;泪小管阻塞伴鼻泪管阻塞9例10眼;泪总管阻塞伴鼻泪管阻塞8例8眼。合并慢性泪囊炎患者36例38眼,其中慢性泪囊炎急性感染后并发泪囊粘液性囊肿2例2眼、泪囊瘘管1例1眼。均行新型逆行泪道置管术治疗,术后第1日起以硫酸庆大霉素氯化钠注射液冲洗泪道,每日1次,冲洗1周;随后冲洗泪道每周1次,冲洗4周;继续每月冲洗泪道1次至拔管;术后予左氧氟沙星滴眼液每日4次滴术眼、盐酸左氧氟沙星眼用凝胶每晚睡前1次涂术眼下结膜囊,共4周,视病情决定是否继续用药;根据患者具体情况,于术后3个月拔除置管,拔管后每月冲洗泪道1次,病情稳定后择期行泪道冲洗,拔管后随访观察3～24个月。以拔管后末次随访时泪道冲洗情况结合泪溢症状改善情况作为评价标准,总体分为有效和无效,其中有效包括治愈和显效。结果:1.共行手术72例77眼,其中71例76眼手术过程顺利,1例1眼手术失败,手术成功率98.70%。2.除外1例1眼手术失败患者,术后对71例76眼患者进行随访,据患者末次复诊情况统计结果,总有效率为92.10%,包括:①53例56眼于术后随访期间泪道冲洗通畅,均于末次复诊时表示无明显泪溢症状,治愈率73.68%;②12例14眼泪道冲洗通畅,但冲洗时伴有一定阻力,且均可见少量返流液,返流液中无明显分泌物,于末次复诊时表示偶有室内流泪现象,显效率18.42%。3.6例6眼,泪道阻塞复发,无效率为7.90%,其中5眼术前伴有不同程度的慢性泪囊炎。4.对不同类型泪道阻塞手术疗效对比分析χ2值为5.077,P=0.279,认为不同类型泪道阻塞手术治疗有效率之间无统计学意。5.对术前是否合并慢性泪囊炎进行疗效对比分析χ2值为2.895,P=0.089,差异无统计学意义。结论:1.新型泪道逆行置管术以特制的泪道探针准确地将泪道引流管从隐蔽的鼻泪管下口置入泪道,有效解决了以往置管术中的难点,手术成功率高。2.新型泪道逆行置管术配合后续泪道冲洗,操作简单且术后并发症少,对泪道阻塞及慢性泪囊炎具有肯定的疗效,是一种适于广泛推广的泪道微创疗法。3.术前严格掌握手术适应症以及排除相关疾病是手术成功的必要条件。4.不同类型泪道阻塞经手术治疗后疗效之间差异无统计学意义,需进一步扩大样本研究。5.术前伴有慢性泪囊炎的患者术后泪道阻塞复发例数更多,但差异无统计学意义,需进一步扩大样本研究。6.该手术方法对慢性泪囊炎导致的泪囊粘液囊肿的治疗效果欠佳,对于此类患者应考虑其他手术方式治疗。
[Abstract]:Objective: The purpose of this study is to investigate the clinical therapeutic effect and experience of the novel retrograde lacrimal passage in the treatment of lacrimal passage obstructive disease. Methods: 72 patients with lacrimal obstruction were collected from March 2012 to June 2016 at the First Affiliated Hospital of Dalian Medical University, with age of 31 ~ 76 years old, middle age 56 years old, course of 6 months ~ 20 years, middle position course in 48 months, among them 19 patients with 20 eyes, Fifty-five female patients (57 eyes), male: female = 1: 2.74, right eye disease (28 cases), left-eye disease (39 cases) and bilateral eyes (5 cases). There were 6 7 eyes (1 eyes complicated with small lacrimal duct stone) in the patients with simple lower lacrimal duct obstruction, 10 cases of lacrimal duct obstruction, 39 patients with nasolacrimal duct obstruction, 9 cases with lacrimal duct obstruction with nasolacrimal duct obstruction, 8 eyes blocked with nasolacrimal duct obstruction with nasolacrimal duct obstruction. Thirty-eight eyes of 36 patients with chronic dacryocystitis were combined, including 2 cases of chronic dacryocystitis after acute infection, 2 eyes in lacrimal sac mucinous cyst, and 1 eye in lacrimal sac. All the patients were treated with a new type of retrograde lacrimal passage, and the lacrimal passage was flushed with gentamicin sulfate sodium chloride injection on the 1st day of the operation, once a day for 1 week, followed by flushing the lacrimal passage once a week for 4 weeks, and continuously flushing the lacrimal passage once a month for one time to the extubation; After the operation, the left ofloxacin eye drops were administered 4 times a day, and the left ofloxacin eye gel was applied to the conjunctival sac once every night for 4 weeks to determine whether to continue the administration according to the condition of the patient; according to the specific condition of the patient, a tube was pulled out for 3 months after operation, After extubation, the lacrimal passage was washed once a month. After the condition was stable, the lacrimal passage was washed, and the follow-up observation was observed for 3-24 months after extubation. In the last follow-up at the end of extubation, the improvement of lacrimal passage was considered as an evaluation criterion, which was divided into effective and ineffective, among which the cure and the effect were effectively included. Result: 1. 72 cases of 77 eyes were operated in total, of which 71 cases had smooth operation, 1 case had failed operation, and the success rate was 98. 70%. The total effective rate was 92.9% in 71 patients with 76 eyes, except 1 case with 1 eye surgery. The total effective rate was 92. 10%. The cure rate was 73. 68%, while in 12 patients with 14 tears, there was a certain resistance. There was no obvious secretion in the back flow. There was no obvious secretion in the return fluid. In the end of the last visit, there was no obvious secretion. The effective rate was 18. 42%. In 6 eyes, the lacrimal passage blocked the recurrence with no efficiency of 7. 90%. Of which 5 eyes were accompanied by a different degree of chronic dacryocytis. The comparative analysis of the curative effect of different types of lacrimal duct obstruction was 5. 077, P = 0. 279. There was no difference in the effective rate between different types of lacrimal duct obstruction. There was no significant difference in the curative effect between the patients with chronic dacryocytis before and after the operation, the difference was 2. 895, P = 0.089, and the difference was not statistically significant. Conclusion: 1. A new lacrimal passage method is used to accurately place the lacrimal drainage tube from the concealed nasolacrimal duct into the lacrimal passage through a special lacrimal passage probe, thereby effectively solving the difficulties in the prior art, and the operation is simple. the novel lacrimal passage retrograde pipe operation is matched with the subsequent lacrimal passage for flushing, has simple operation and few postoperative complications, has definite curative effect on the obstruction of the lacrimal passage and the chronic dacryocytis, and is a lacrimal passage micro-wound therapy suitable for wide popularization. Intraoperative strict mastery of surgical indications and exclusion of related diseases is a necessary condition for the success of surgery. 4. There was no significant difference in the efficacy of different types of lacrimal duct obstruction after operation, and the sample study was further expanded. There were more patients with chronic dacryocystitis after operation, but there was no statistical significance in the difference. The surgical method has poor curative effect on lacrimal sac mucocele caused by chronic dacryocystitis, and other surgical methods should be considered for such patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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