【摘要】 目的：应用静脉留置针与硅胶管应用于泪小管断裂吻合术中的临床疗效。方法：将泪小管断裂患者100例(100眼)按照随机的原则分成2组：A组(静脉留置针组)50眼,B组(硅胶管组)50眼，观察手术后6mo溢泪及冲洗泪道通畅情况。结果:A组中治愈49眼(98.0％)；B组中治愈46眼(92.0％)。A组与B组疗效相比差异有显著意义(P<0.05)。结论：静脉留置针治愈率最高，留置于吻合道中，对防止粘连、抑制纤维化及减轻吻合口收缩起重要作用，是较为安全，有效，使用方便理想的留置物。
【关键词】 静脉留置针；泪小管断裂；吻合术
Vein detained needle insertion compared to silicone tube application in ruptured lacrimal canaliculi
LiHua Huang,Yi Shao,HuiKang Chen,Yu Deng,Min Xiao,ZhouHua Peng
1Department of Ophthalmology, the Second Peoples Hospital, Pingxiang 337000, Jiangxi Province, China;2Department of Ophthalmology, the First Affiliated Hospital, the Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
Correspondence to:LiHua Huang. Department of Ophthalmology, the Second Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China. huanglihua9585＠yahoo.com.cn
Abstract AIM: To evaluate the clinical effect of two different filling materials on treating lacrimal canaliculi rupture: vein detained needle, silicone tube.METHODS: One hundred patients (100 eyes) with lacrimal canaliculi rupture were divided into two groups: group A (50 eyes) received vein detained needle as a filling material in lacrimal canaliculi rupture; group B (50 eyes) received silicone tube. The condition of epiphora and syringing of the lacrimal passage were observed in six months after the operation continuously.RESULTS: In group A,there were 49 eyes cured(98.0％),while 46 eyes were cured (92.0％) in group B. There was a significant statistical difference between two groups in the surgical success rate and the operative complications (P<0.05). CONCLUSION: It is believed that group A with higher success rate, fewer operative complications and high patient satisfaction can be used to simplify. Vein detained needle plays. an important role in preventing adhesion and inhbiting fibrous tissue growth and reducing contraction of anastomosissite. Vein detained needle is a safe, effective and ideal filling material for treatment of lacrimal canalicular rupture.
KEYWORDS: vein detained needle; lacrimal canaliculi rupture; anastomosis
0引言
泪小管断裂是临床上最常见的眼外伤之一，以下泪小管断裂为多见。治疗泪小管断裂目的不仅需要解剖复位，减少术后疤痕形成，而且要求泪道功能得到恢复。而寻找并检出泪小管鼻侧断端，支撑物的植入和固定是泪小管断裂吻合成功的关键。由于泪小管开口纤维组织增生，肉芽和瘢痕形成等常见原因，仍有部分病例术后失败。为了提高手术成功率，减少术后出血，使吻合腔道足够大，术后置放何种引流物于吻合腔内也就至关重要。我院2000/2005年收治的100例分别采用静脉留置针与硅胶管2种材料治疗泪小管断裂,采用两样本t检验对其基本资料、临床疗效等方面进行比较分析，现报告如下。
1对象和方法
1.1对象
随机选择2002/2005年泪小管断裂住院患者共100例(100眼)，均为单眼。年龄12～68（平均42）岁。男44例，女56例。病程1mo～6a，平均83d。致伤原因主要有拳击伤，车祸伤，锐器伤，摔伤等。根据在泪小管断裂吻合术中留置物不同分成2组；A组为静脉留置针组，B组为硅胶管组，详细资料(表1)。手术器械：泪点扩张器，泪道探针，螺旋状猪尾探针，静脉留置针，0.8mm硅胶管。表1 两组患者年龄、病程比较(略)
1.2方法
常规消毒、铺巾、局部麻醉，用泪点扩张器扩张泪小点。A组：用苏州产一次性静脉留置针，规格直径0.9mm，长度2.5mm，平管腔口磨平针蕊，使之变钝，从泪小点插入泪小管颞侧断端。在显微镜下寻找泪小管鼻侧断端，如断端<6mm一般可见呈淡红色的环形小口，用静脉留置针直接插入其内，触及泪囊骨壁时轻抵骨壁为支点，将针头从水平紧贴前额部旋转90°至额际，将针徐徐稍向后下方鼻泪管方向推进。鼻侧断端距下泪小点>6mm此时断端退缩于眼轮匝肌内，甚至伤口撕裂至泪囊，此时用上泪小管注气或注水法辅助寻找断端，如损伤泪囊，可寻找到光滑、淡红色的泪囊粘膜，用同上方法吻合泪小管，拔出针蕊注生理盐水于留置管内，如冲洗通畅无阻力，示手术成功，80线缝合吻合口3针，皮下及皮肤缝合，皮肤固定。涂抗生素眼膏包术眼，绷带轻度加压。8～12wk拔管。B组：用螺旋状猪尾探针从上泪点进入，从下泪点鼻侧断端穿出，在猪尾探针头部孔内穿入长约20cm 30丝线,然后从上泪点退出猪尾探针带出丝线，在丝线下l/3处打一活结，活结内套入直径0.8mm硅胶管，从下泪小管鼻侧断端拉动丝线带出硅胶管 再用泪点扩张器和探针扩张颞侧断端泪小管，用猪尾探针从下泪点穿入，从颞侧断端穿出.在猪尾探针头部孔内穿入来自鼻侧断端的丝线，然后从下泪点退出猪尾探针，拉出丝线带出硅胶管。在手术显微镜下用90丝线在下泪小管断端上、下和前方各缝1针后结扎。间断缝合眼睑裂伤。将从上下泪点出来的硅胶管作一环行结扎放置内眦部，同时固定于下睑皮肤。3mo后拔管。
2结果
疗效标准：患者无自觉不适，无溢泪，泪道冲洗通畅为治愈；有溢泪，不通畅伴有睑内翻等并发症均为无效。A组50眼治愈49眼（98.0%）；B组50眼治愈46眼（92.0%），A、B组无效者以陈旧性泪小管断裂患者为主；两者治愈率比较，差异有显著意义（P<0.05）。术后追踪时间2a者22例，1a者38例，0.5a者29例，3mo者8例，2mo者3例。
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