【摘要】 目的：探讨不同情况下外伤性泪小管断裂吻合的简单有效方法。方法：回顾性分析住院治疗的73例外伤性泪小管断裂患者资料，归纳其手术方法和临床特点，并且随访。手术方法分别采用直接寻找法，弯针法，泪囊切开法。结果：经治疗73例患者中直接寻找法吻合56例，弯针法吻合15例，泪囊切开法吻合2例。泪小管断裂吻合治愈63例，好转9例，未愈1例。结论：大多数新鲜泪小管断裂可以直接找到鼻侧断端，少数可以用弯针法找到，个别解剖异常患者或陈旧性泪小管断裂患者需用泪囊切开法。
【关键词】 泪小管;断裂;吻合
Clinical analysis of three kinds of lacerated lacrimal canaliculus anastomosisChengHua Wei, Ping Lang, LiXin Mei, RuiLing CaiDepartment of Ophthalmology, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, ChinaAbstractAIM: To study the effective method of traumatic lacrimal canaliculus anastomosis. METHODS: Seventythree eyes with lacrimal canaliculus disease caused by trauma were analyzed retrospectively, and its surgical methods and clinical characteristics were summarized. And then the patients were followed up. Surgical methods included direct searching method, curved needle method and lacrimal sac incision.RESULTS: In 73 cases, 56 cases underwent direct searching method, 15 cases adopted curve needle method and 2 cases underwent incision of lacrimal sac. The operation was successfully performed in 63 cases, improved in 9 cases and ineffective in 1 case. CONCLUSION: Nasal stump of most of the fresh canalicular lacerations can be found directly, a few could be found by curved needle, stump in individual patients with anatomical abnormalities or old canalicular laceration need to be found with lacrimal sac incision.
KEYWORDS: lacrimal canal; laceration; anastomosis
0引言
泪小管断裂是常见的眼附属器外伤性疾病，如不及时吻合，可导致溢泪等后遗症。兹对20050101/20090630在我院住院治疗的73例外伤性泪小管断裂患者资料进行回顾性分析。我们在显微镜下分别采用直接寻找法、弯针法[1]或泪囊切开法寻找泪小管鼻侧断端，用硬膜外导管为支架，修复泪小管断裂，操作简便，效果确切，现报告如下。
1对象和方法
1.1对象
回顾性分析20050101/20090630住院治疗的73例外伤性泪小管断裂患者，其中男60例，女13例，男女比例为4.6∶1;右眼37例，左眼36例;年龄10～72(平均43.8)岁。致伤原因：车祸34例，其中骑模特车或电动车15例;工伤18例;发生纠纷受伤10例，其中拳击伤6例;日常生活中受伤8例;其它原因3例。归纳其手术方法和临床特点。资料主要来源于病案室病历资料，手术室登记本及出入院登记本。
1.2方法
1.2.1寻找鼻侧泪小管断端手术方法
直接寻找法:在显微镜下根据泪小管解剖行径及与内眦韧带的相对解剖位置寻找泪小管鼻侧断端，泪小管鼻侧断端距离泪小点<6mm者可沿内眦部睑缘寻找，>6mm的下泪小管断裂则在靠近内眦韧带下方寻找鼻侧断端。泪小管断端呈白色或粉红色喇叭口状，外观有光滑黏膜面内壁的管状结构,插入泪道冲洗针,注入生理盐水，患者自觉有液体流入鼻腔,以此证实为鼻侧泪小管断端;弯针法:对于断端靠近鼻侧且鼻侧泪小管黏膜在显微镜下不明显者，用弯泪道探针从对侧未损伤泪小点(管)，经泪总管(泪囊)从泪小管的鼻侧断端穿出，再注入生理盐水证实为鼻侧泪小管断端，从而进行吻合;泪囊切开法：对于断端靠近鼻侧且存在解剖变异无法用弯针法寻找的病例，可在内眦韧带处切开泪囊，逆行寻找泪小管的鼻侧断端。
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