不同吻合環形置管術治療淚小管斷裂的療效研究

蔡樹泓，張世華，宋青山

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不同吻合環形置管術治療淚小管斷裂的療效研究

蔡樹泓1，張世華1，宋青山2

1Department of Ophthalmology, the First People’s Hospital of Huizhou, Huizhou 516001, Guangdong Province, China;2Department of Ophthalmology, Central People’s Hospital of Huizhou, Huizhou 516001, Guangdong Province, China

?METHODS: Retrospective analysis. A total of 114 cases 114 eyes were randomly selected between May 2013 to May 2015 jointly admitted to Huizhou Huizhou City People’s Hospital and the Central People’s Hospital of canalicular patients in accordance with the agreement of the annular catheterization divided into three groups, group A of annular nasal lacrimal duct catheterization in 36 eyes, group B for the whole nasal lacrimal annular catheterization in 33 eyes, group C between the upper annular tears point catheterization 45 eyes. Through the A, B, C three groups after 1, 3wk, 1, 3mo and 1y follow-up were analyzed to compare.

?RESULTS: Group A of 31 eyes were cured, improved in 2 eyes, 3 eyes, the effective rate was 91.7%; group B, 27 cases were cured, improved in 3 eyes, 3 eyes, the effective rate was 90.9%; group C, 40 cases were cured, improved in 2 eyes, 3 eyes, the effective rate was 93.3%. A, B, C three groups efficiency pointless difference(P=0.124). Eye Effect: A, B, C meaningful difference among the three groups(F=36.578;P=0.002), Group A scored the highest score of a minimum group C, respectively(3.5±0.8) and(2.3±0.7); comparison meaningless difference between group a and group B(t=0.086,P>0.05); Group A and C and comparison of differences between group C and group B have the significance(t=15.241,t=17.472;P<0.05). Nasal influence: A, B, C meaningful difference among the three groups(F=778.581;P=0.001), the highest score in group B, group C minimum scores were(6.6±0.8) and(0.9±0.7); A, B, C three groups comparison of differences twenty-two have significance(t=17.262;t=18.247;t=16.647;P<0.05). Shape Effect: A, B, C difference among the three groups of meaningful(F=481.113;P=0.002), Group A scored the highest score of a minimum group C, respectively(5.8±0.9) and(1.2±0.6); Compare the difference between Groups B and C meaningless(t=0.087,P>0.05); comparing the differences between the Groups A and B and between Group A and C were significance(t=26.362,t=27.532;P<0.05). Unplug risk: A, B, C meaningful difference among the three groups(F=751.121;P=0.003), Group A scored the highest score of a minimum group C, respectively(6.5±0.7) and(1.5±0.7); A, B, C three groups comparison of differences twenty-two have significance(t=19.642;t=20.153;t=18.345;P<0.05). Group A had 8 patients had lower eyelid eversion, 5 cases of inferior lacrimal point expansion, 13 cases of sneezing, itchy nose, runny nose syndrome. Group B had 20 cases of varying degrees of now sneezing, itchy nose, runny nose syndrome. Group C had no serious complications.

?CONCLUSION: Similar to A, B, C three groups of treatment efficacy, patient lacrimal functional recovery is safe and effective, which the group C treatment, during treatment and less material and fewer postoperative complications in patients, it is worth promotion.

目的：探討不同吻合環形置管術治療淚小管斷裂療效。

方法：采用回顧分析法。選取2013-05/2015-05惠州市第一人民醫院和惠州市中心人民醫院共同收治的淚小管斷裂患者114例114眼，按照吻合環形置管方法的不同分為三組，A組為淚道鼻腔環形置管36眼，B組為鼻內全淚道環形置管術33眼，C組為上下淚點間環形置管術45眼。觀察三組術后1、3wk,1、3mo，1a的隨訪情況進行分析比較。

結果：A組治愈31眼，好轉2眼，無效3眼，有效率為91.7%；B組治愈27眼，好轉3眼，無效3眼，有效率為90.9%；C組治愈40眼，好轉2眼，無效3眼，有效率為93.3%。三組有效率差異無統計學意義(P=0.124)。眼部影響：三組間的比較差異有統計學意義(F=36.578，P=0.002)，A組得分最高，C組得分最低，分別為3.5±0.8、2.3±0.7分，A組和B組間的對比差異無統計學意義(t=0.086，P>0.05)；A組和C組及C組和B組的對比差異均有統計學意義(t=15.241、17.472，均P<0.05)。鼻部影響：三組間的比較差異有統計學意義(F=778.581，P=0.001)，B組得分最高，C組得分最低，分別為6.6±0.8、0.9±0.7分；三組間兩兩對比差異均有統計學意義(t=17.262、18.247、16.647，均P<0.05)。外形影響：三組間的比較差異有統計學意義(F=481.113，P=0.002)，A組得分最高，C組得分最低，分別為5.8±0.9、1.2±0.6分；B組和C組間的對比差異無統計學意義(t=0.087，P>0.05)；A組和C組間及A組和B組間的對比差異均有統計學意義(t=26.362、27.532，均P<0.05)。拔出風險：三組間的比較差異有統計學意義(F=751.121，P=0.003)，A組得分最高，C組得分最低，分別為6.5±0.7、1.5±0.7分；三組間兩兩的對比差異均有意義(t=19.642、20.153、18.345，均P<0.05)。A組出現下瞼外翻8眼，下淚小點擴張5眼，出現打噴嚏、鼻癢、流涕癥13眼。B組出現不同程度的現打噴嚏、鼻癢、流涕癥20眼。C組沒有出現嚴重并發癥。

結論：三組的治療方案療效類似，對患者淚道的功能恢復安全有效，其中上下淚點間環形置管術治療過程中材料使用少，且術后患者的并發癥少。

淚小管斷裂；環形吻合置管術；硅膠管

引用：蔡樹泓，張世華，宋青山.不同吻合環形置管術治療淚小管斷裂的療效研究.國際眼科雜志2016;16(11):2157-2159

0　引言

隨著社會和經濟的快速發展，人們的生活和生存環境發生了翻天覆地的變化，眼科疾病越來越多，呈逐年上升趨勢，淚小管斷裂是眾多眼科疾病中常見的一種[1-2]。目前……