慢性泪道阻塞及泪囊炎微创治疗法实验和临床研究

发布时间：2018-04-27 15:59

本文选题：硬化剂 + 新型泪道成形器　；参考：《天津医科大学》2010年硕士论文

【摘要】： 目的慢性泪道阻塞和泪囊炎是眼科的常见病,同时又是眼内手术前必须消除的疾病。本研究包括两部分：第一部分是探索一种快速微创治疗泪囊炎的方法的实验研究,取代泪囊摘除术。第二部分使用拥有自主知识产权的专利产品对慢性泪道阻塞和泪囊炎患者进行全泪道钻切成形术的回顾性临床研究。对象方法 1.选择新西兰大白兔为实验动物,将7只白兔随机分成对照组(1只兔)平阳霉素组简称“平阳组”(6只左眼)、磷霉素钠葡萄糖组简称“磷葡组”(6只右眼)。对照组药物为0.9%的生理盐水；平阳组药物为平阳霉素、地塞米松、利多卡因、0.9%的生理盐水；磷葡组药物为磷霉素钠粉、50%葡萄糖。对白兔泪道按照泪道冲洗操作规范分别注入上述药物,在给药后1周、2周两个不同时间段解剖分离出泪囊并观察其组织病理形态学变化。 2.回顾性病例研究,收集2006年8月至2009年1月在天津医科大学总医院眼科门诊治疗的90例(90只眼),其中慢性泪道阻塞40眼,慢性泪囊炎43眼,急性泪囊炎7眼,对泪道冲洗探通及激光治疗失败的患者局麻下行“经泪小点全泪道钻切成形术”治疗。患者年龄范围22岁到86岁,平均53岁。随访时间为3-32个月,平均随访时间10个月。对该方法治疗慢性泪道阻塞、急性和慢性泪囊炎的疗效、术中术后并发症及影响疗效的因素进行分析。结果 1.对照组无明显变化,泪道黏膜为柱状上皮,结构基本正常；给药后1周平阳组泪道冲洗通畅,泪道黏膜水肿、增生,有炎症细胞浸润；磷葡组泪道冲洗不通畅,黏膜水肿、增生、炎症细胞浸润；给药后2周平阳组泪道冲洗通畅、泪道黏膜上皮细胞增生结构紊乱、少量上皮细胞内陷入软组织中、炎症细胞浸润；磷葡组泪囊组织炎性细胞浸润、黏膜上皮细胞大部分缺失、泪囊腔内可见血液和胶原渗出,泪囊腔狭窄,泪囊明显萎缩,与周围组织未见明显粘连。 2.“经泪小点全泪道钻切成形术”(TPLD)后77只眼(85.6%)治愈,9只眼(10%)好转,4只眼(4.4%)泪道冲洗不通畅。术中及术后并发症包括下睑皮肤肿胀淤血、18只眼(20%)脱管、4只眼(4.4%)发生泪小管撕裂。43例慢性泪囊炎患者中33只眼(76.7%)治愈,7只眼(16.3%)好转,3只眼(7.0%)冲洗泪道不通畅。急性泪囊炎7例均在2-3周内消肿,5例泪道冲洗通畅,泪囊脓液消失,2例挤压泪囊仍有少量脓液。结论 1.磷霉素钠葡萄糖泪道注射硬化疗法对实验性兔泪道有较好的闭塞作用,2周即可导致泪囊萎缩,效果优于平阳霉素。磷霉素钠主要由胶原纤维增生导致管壁增厚、副作用小、并发症少,考虑到高渗糖和磷霉素钠都可在人体内重吸收,不但硬化效果好,而且残留少、无刺激,磷霉素钠还有防治细菌感染作用,临床上尤其适用于合并全身并发症无法实施或不愿意手术的老年慢性泪囊炎患者,有着重要的临床应用价值。 2.“经泪小点全泪道钻切成形术”(TPLD)治疗泪道阻塞性疾病疗效确切,其中治疗慢性泪道阻塞疗效优于慢性泪囊炎。同时患者良好的依从性及规律的术后冲洗护理对手术疗效起着至关重要的作用。“新型泪道成形器”(LDST)是种便捷、安全、经济的手术器械,手术方法容易被眼科医师所掌握,适合在广大基层医院尤其是边远地区推广应用。
[Abstract]:objective
Chronic lacrimal duct obstruction and dacryocystitis are common diseases in the ophthalmology and must be eliminated before intraocular surgery. This study includes two parts: the first part is to explore an experimental study of a rapid and minimally invasive treatment of dacryocystitis, instead of dacryocyst extirpation. The second part uses patent products with independent intellectual property rights to chronic tears. Retrospective clinical study of total lacrimal duct drilling for patients with obstruction and dacryocystitis.
Object method
1. the New Zealand white rabbits were selected as the experimental animals, and 7 rabbits were randomly divided into the control group (1 rabbits), the Pingyang mycophencin group was referred to as "Pingyang group" (6 left eyes), and the phosphamycin sodium glucose group was referred to as "the phosphorus group" (6 right eyes). The control group was 0.9% of the saline, and the Pingyang group was Pingyang mycin, dexamethasone, lidocaine, 0.9%. The medicine of group phosphorus was fosfomycin sodium powder and 50% glucose. The white rabbit lacrimal duct was injected into the lacrimal duct according to the standard of lacrimal duct rinsing operation. The lacrimal sac was dissected at 1 weeks after the administration and 2 weeks at two different periods, and the histopathological changes were observed.
2. retrospective case studies were conducted to collect 90 cases (90 eyes) in the ophthalmology department of General Hospital Affiliated to Tianjin Medical University from August 2006 to January 2009, of which 40 eyes were blocked by chronic lacrimal duct obstruction, 43 eyes of chronic dacryocystitis, 7 eyes of acute dacryocystitis, and "teardrop total lacrimal passage drilling" under local anesthesia for lacrimal duct flushing and laser treatment. The patients were aged from 22 to 86 years old, with an average of 53 years of age. The follow-up time was 3-32 months and the average follow-up time was 10 months. The treatment of chronic lacrimal duct obstruction, acute and chronic dacryocystitis, postoperative complications and factors affecting the effect were analyzed.
Result
There was no obvious change in the 1. control group. Lacrimal duct mucosa was columnar epithelium and the structure was normal. The lacrimal duct was flushed and smooth in Pingyang group 1 weeks after administration. The mucous membrane of lacrimal duct was edema, hyperplasia and infiltration of inflammatory cells. The lacrimal passage was flushed without patency, mucous edema, hyperplasia and infiltration of inflammatory cells. The lacrimal duct of the Pingyang group was flushed and smooth and mucous epithelium of lacrimal passage after 2 weeks of administration. The cell proliferation was in disorder, a small amount of epithelial cells were trapped in soft tissue, inflammatory cells infiltrated, inflammatory cells infiltrated in the lacrimal sac tissue, most of the mucous epithelial cells were missing, the blood and collagen exudation were found in the lacrimal sac cavity, the lacrimal sac cavity was narrow, the dacryocyst atrophied obviously, and no obvious adhesion was found in the circumference tissue.
2. "TPLD", 77 eyes (85.6%) were cured, 9 eyes (10%) improved, 4 eyes (4.4%) unobstructed lacrimal passage. Complications included swelling and congestion of the lower eyelid skin, 18 eyes (20%), 4 eyes (4.4%) tear ducts, 4 eyes (76.7%) in patients with chronic dacryocystitis, and 85.6% eyes (76.7%) cured, 4 eyes (76.7%) cured, 4 eyes (76.7%) cured, 7 eyes (76.7%) 6.3%) improvement, 3 eyes (7%) flushing lacrimal duct unobstructed. 7 cases of acute dacryocystitis all disappeared within 2-3 weeks, 5 cases of lacrimal duct flushed, lacrimal sac pus disappeared, 2 cases of squeezing lacrimal sac still had a small amount of pus.
conclusion
1. fosfomycin sodium glucose lacrimal duct injection hardening therapy has a better occlusion effect on experimental rabbit lacrimal duct. It can cause dacryocyst atrophy in 2 weeks. The effect is better than that of Pingyang mycophencin. The effect of sclerotherapy is good, and the residue is little, no stimulation, and fosfomycin sodium has the effect of preventing bacterial infection. It is especially suitable for the elderly patients with chronic dacryocystitis which can not be implemented or would not be willing to be operated on.
2. "TPLD" is effective in the treatment of lacrimal duct obstruction, and the treatment of chronic lacrimal duct obstruction is better than chronic dacryocystitis. The good compliance and regular postoperative nursing care of the patients plays a vital role in the surgical effect. "New LDST" is a kind of convenience, Safe, economical surgical instruments and surgical methods are easy to be grasped by ophthalmologists. They are suitable for popularization and application in the grass-roots hospitals, especially in remote areas.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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