【摘要】 目的：探讨寻找近端断裂泪小管的方法和引线硅胶管植入在泪小管吻合术中的应用效果。方法：回顾研究我院近5a的18例泪小管断裂的病例资料，采用显微镜下直接暴露泪小管，引线硅胶管作为支撑行泪小管吻合，分析其预后。结果：患者18例手术均顺利成功，随访6mo，泪道冲洗均通畅。结论:显微镜下直接暴露泪小管能快速找到近端断裂泪小管，使用硅胶管作为支撑可以有效提高舒适度和降低手术并发症。
【关键词】 泪小管断裂;引线硅胶管;吻合术;显微手术
Application of the linedrafted silicone tube in the nasolacrimal anastomosis
DingWang Su, Shui Liu, JiaoYi Liu
Department of Ophthalmology, Zhongshan Torch Development Zone Hospital, Zhongshan 528437, Guangdong Province, China
Correspondence to: DingWang Su. Department of Ophthalmology, Zhongshan Torch Development Zone Hospital, Zhongshan 528437, Guangdong Province, China. [email protected].
Received:20100531 Accepted:20100806
Abstract
AIM: To discuss the method of finding the rupture point of the lacrimal canaliculus and the result of applying the linedrafted silicone tube in the nasolacrimal anastomosis.
METHODS: Retrospectly 18 cases 18 eyes with lacrimal canaliculus rupture in our hospital in the past five years were studied, the research contained the method of seeking the rupture point of the lacrimal canaliculus under the operating microscope and the result of using of the silicone tube as a support for lacrimal canaliculus for nasolacrimal anastomosis.
RESULTS: Totally 18 cases were all successful and irrigation of lacrinal passages was good in half a year.
CONCLUSION: Seeking the rupture point of the lacrimal canaliculus under the operating microscope is easy and implanting the silicone tube as a support can make patients more comfortable and reduce postoperative complications.
KEYWORDS: lacrimal canaliculus rupture; linedrafted silicone tube; anastomosis; microsurgery
Su DW, Liu S, Liu JY. Application of the linedrafted silicone tube in the nasolacrimal anastomosis. Int J Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):18251826
泪小管断裂是临床常见的眼科急症，如果不能及时找到泪小管并吻合将造成终生溢泪。泪小管断端的寻找方法非常多，譬如猪尾钩、黏弹剂、染色剂、牛奶等。我们在临床实践中发现显微镜下缝线牵引的直接暴露法寻找泪小管断裂端非常有效，同时使用引线硅胶管作为支撑，收到非常好的效果。现报告如下。
1对象和方法
1.1对象
泪小管断裂18例18眼，男17例，女1例，年龄12～71岁;职业为工人12例，农民3例，学生3例。仅2例为上泪小管断裂，其余为下泪小管断裂。外伤原因多为异物击伤、车祸、摔伤和狗抓伤，就诊时间30min～16h。
1.2方法
取一棉签点几滴5g/L丁卡因溶液及呋嘛滴鼻液塞入下鼻道做表面麻醉，20g/L利多卡因和7.5g/L布比卡因(1∶1)筛前神经及眶下神经各注射2mL做局部浸润麻醉。清除伤口的污物：用8g/L庆大霉素生理盐水冲洗和去除伤口污物。寻找泪小管：先用50丝线做3～6个伤口的牵引缝线，暴露伤口;上显微镜，放大5～8倍，顺着解剖位置可以较快地找到微白色呈喇叭口的有光滑黏膜内壁的管状组织即为泪小管，向该组织内注生理盐水，如鼻腔或者咽部有水则可确认;本组的病例通过充分暴露后全部可以找到。植入引线型硅胶管：套件由广州市博士眼科研究所提供，有7号钝头8cm长的腰穿针一个、金属小钩一个、引线硅胶管一条;腰穿针中穿50丝线，线两端打结备用。先送引线：扩张泪点，腰穿针带线从泪点，经泪小管断端、泪总管、泪囊、鼻泪管进入下鼻道，用小钩从鼻腔勾出引线，退出腰穿针，留下引线;上下泪小管各送一条引线。植入硅胶管：引线硅胶管头端先与下泪小管的引线鼻腔外端打结，牵拉使硅胶管头端从鼻腔入、下泪点出;硅胶管头端再与上泪小管的引线打结，牵拉使硅胶管从上泪点入至鼻腔出;引线硅胶管两末端在鼻腔打结，这样在泪阜处形成一条连接上下泪点的硅胶管C型襻。吻合泪小管：显微镜下用70可吸收缝线间断对位缝合泪小管壁周围组织共3针;伤口肌层皮肤逐层对位缝合。术后处理：抗生素滴眼液滴眼，不用冲洗泪道，7d后拆除皮肤缝线，3mo拆除硅胶管，连续冲洗泪道3d，后定期冲洗泪道6mo。
2结果
2.1手术疗效判定标准
治愈：泪道冲洗通畅，无溢泪;好转：泪道冲洗通畅，但仍溢泪;未愈：泪道冲洗不通，有溢泪。
2.2手术效果
拔管后随访3mo，18例拔管后均出现不同程度的泪点扩张，但没有1例出现撕裂，3mo复查泪点基本全部复原，泪道冲洗均通畅，无1例溢泪，无其他并发症。
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