【摘要】 目的：观察泪道探通、激光泪道成形术联合典必殊眼膏泪道注药留置治疗泪道阻塞的临床疗效。方法：接受泪道探通、激光泪道成形术的患者128例196眼，术中联合泪道注入典必殊眼膏，术后每5～7d酌情再次或多次注药，回顾分析应用效果。 结果：泪道探通联合注药154眼，有效119眼，有效率为77.3%;激光泪道成形联合注药42眼，有效34眼，有效率为81.0%;总有效率为78.1%。结论：典必殊眼膏泪道注药留置在泪道探通、激光泪道成形术联合应用具有较好疗效。
【关键词】 泪道阻塞，慢性泪囊炎;泪道探通术;激光泪道成形术;典必殊眼膏
Treating lacrimal ducts obstruction by dredged combining injecting Tobradex ointment into lacrimal passage
Zong-Duan Zhang
Eye Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China.
Correspondence to: Zong-Duan Zhang. Eye Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China. [email protected]
Received:2007-02-12 Accepted:2007-05-16
Abstract AIM: To study and analyze the clinical effect of probing of lacrimal passages, transcanalicular laser-assisted dacryocystoplasty combining injecting Tobradex ointment into lacrimal passage in the treatment of lacrimal ducts obstruction. METHODS: A total of 128 patients (196 eyes) with lacrimal ducts obstruction were treated with probing of lacrimal passages or transcanalicular laser-assisted dacryocystoplasty. Meanwhile, all of them were injected with Tobradex ointment into their lacrimal passage. Then every 5-7 days after treatment, Tobradex ointment was injected again according to the patients' reaction. The effects were retrospectively analyzed. RESULTS: Among the 154 eyes treated by probing of lacrimal passages and Tobradex ointment injection, the treatment was effective in 119 eyes (77.3%). Among the 42 eyes treated by transcanalicular laser-assisted dacryocystoplasty and Tobradex ointment injection, the treatment was effective in 34 eyes (81.0%). The total effective rates were 78.1%. CONCLUSION: Injection of Tobradex ointment after probing of lacrimal passages or transcanalicular laser-assisted dacryocystoplasty is an effective treatment for lacrimal ducts obstruction.
· KEYWORDS: lacrimal ducts obstruction; chronic dacryocystitis; probing of lacrimal passages; transcanalicular laser-assisted dacryocystoplasty; Tobradex ointment
张宗端.泪道疏通联合典必殊眼膏留置治疗泪道阻塞.国际眼科杂志,2007;7(3):870-871
0引言
泪道阻塞是眼科常见、多发病，可造成溢泪和继发慢性泪囊炎等，常给患者造成身心痛苦。泪道阻塞的治疗方法很多，目前临床有单纯泪道探通、抗菌素泪道注入、泪道置管、泪道挂线、激光泪道成形术等一种或几种手段联合治疗方法，但其治疗手段愈多，表明其中的任一种方法之效果都不理想，泪道阻塞仍然是当今眼科临床疑难杂病之一。2001年前我们曾采用单一激光泪道成形术治疗泪道阻塞，虽治愈率有所提高，但部分患者出现泪道阻塞复发甚至泪道出现更严重瘢痕性阻塞等后果。2001-06/2006-01，采用泪道探通或激光泪道成形术联合典必殊眼膏泪道注药留置治疗，经6～12mo的临床观察，取得较好疗效，现对持续回访6mo以上的128例泪道阻塞患者(196眼)治疗情况报告如下。
1对象和方法
1.1对象 128例(196眼)泪道阻塞患者，男33例(38眼)，年龄13～72(平均34)岁;女95例(158眼)，年龄16～78(平均46)岁;病程3mo～20a，平均3.9a。病例中单纯泪道阻塞者163眼，少数病例伴有粘性分泌物，合并轻度慢性泪囊炎(泪道冲洗少许脓性物返流)者33眼;其中下泪小管阻塞者20眼，泪总管阻塞者32眼，鼻泪管阻塞者108眼，下泪小管或泪总管并鼻泪管同时阻塞者36眼。
1.2方法 患者首诊以带冲洗针头探针(中空，针头钝圆盲端，两侧开有小孔)，用灭菌生理盐水冲洗泪道，尽量冲洗净泪道之粘液性或脓性分泌物，并以该探针探通泪道至鼻腔冲洗通畅(若阻塞十分严重者则不可强行探通)，探查泪道阻塞部位及其阻塞严重程度等情况，病历泪道图示记录并附文字说明。有轻度脓性分泌物者使用抗生素眼药水滴眼3～7d。对下鼻甲肥大、严重鼻息肉等鼻腔疾患者及严重结膜炎者应先予以治疗。常规泪点表面麻醉，用泪点扩张器扩张泪点。对泪道存在膜状、纤维丝状、严重狭窄(冲洗不通但探通并无阻塞)等轻、中度泪阻塞者，尤其是探查泪道无出血或少许出血者，用9号带芯泪道探针按常规泪道探通，拔出针芯，冲洗至鼻腔通畅，以注射器向泪道注入典必殊眼膏约1mL，边注边退，并保证阻塞部位有眼膏留置。对泪道存在严重瘢痕性阻塞或不能强行探通等重度泪阻塞者，确定阻塞部位后，向泪道内注入20g/L利多卡因液0.5mL，用9号带芯泪道探针按常规泪道探通法，从下泪小点插至阻塞处，拔出针芯，抽吸出泪道存留液体，通过空针管引入导光纤维至泪道阻塞处作连续击射，当光纤有落实感后停止击射。灭菌生理盐水冲洗泪道，确认泪道通畅无假道后，如上法注入典必殊眼膏。嘱患者术后勿挤压泪道，有脓性分泌物者抗生素眼药水滴眼。术后1wk冲洗泪道，不通畅者再次泪道探通注药，通畅者第2wk;1，3，6mo复诊冲洗泪道;经连续3～5次注药仍不通畅者改行泪囊鼻腔吻合术(仅留下鼻泪管阻塞者)或其他方法治疗。疗效评定标准：治愈：流泪症状消失，泪道冲洗通畅持续6mo以上者;好转：流泪减轻，泪道冲洗通而不畅持续6mo以上或连续6mo之内经间断1～2次再次注药维持通畅者;无效：流泪，泪道冲洗不通。
2结果
泪道探通联合注药154眼，一次性治愈21眼，2次注药治愈18眼，3次注药治愈32眼，3次以上注药治愈14眼，好转34眼，无效35眼，有效率为77.3%;激光泪道成形联合注药42眼，一次性治愈12眼，2次注药治愈10眼，3次注药治愈5眼，好转7眼，无效8眼，有效率为81.0%。总有效率为78.1%。除极少数患者术毕出现轻度出血、皮下组织肿胀外，无严重并发症发生。
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