激光泪道成形术联合硅胶管置入治疗泪道阻塞疗效观察_医学论文.docVIP

激光泪道成形术联合硅胶管置入治疗泪道阻塞疗效观察_医学论文 激光泪道成形术联合硅胶管置入治疗泪道阻塞疗效观察_医学论文 作者：郭建新，曹恒明，牟 莉，李明新，赵愈敏，孙小静 【摘要】 目的 探讨KTP-Nd:YAG激光泪道成形术联合硅胶管置入对泪道阻塞的治疗效果。方法 67例（70眼）后天发生的泪道阻塞患者（其中上泪道阻塞的患者39眼，下泪道阻塞导致泪囊炎的患者31眼）行泪道激光成形术后置入硅胶管，保留插管3～6个月。术后随访，观察泪道引流泪液功能的恢复情况。结果 拔管后平均随访7.2个月，经泪道冲洗证实共治愈57眼（81.43%），其中上泪道阻塞组32眼（82.05%），下泪道阻塞组25眼（80.65%）。结论 激光泪道成形术联合硅胶管置入能有效治疗上、下泪道阻塞,可作为临床上治疗泪道阻塞的首选方法。 【关键词】 泪道阻塞；激光手术；泪道成形术；硅胶管置入术 Abstract:Objective To evaluate therapeutic effects of KTP laser combined with silicone intubation for lacrimal duct obstruction.Methods The combined procedure of KTP laser and silicone intubation was performed in 67 patients with adult-onset lacrimal duct obstruction in 70 eyes, among which 39 eyes were troubled in the upper common canalicular and 31 eyes in the lower nasolacrimal duct. The silicone tube was kept in place for 3-6 months after surgery. The recovery of function of lacrimal duct was evaluated by the end of a mean follow-up for 7.2 months after extraction of the silicone tube.Results Irrigating test of the lacrimal passage showed 57 out of the 70 troubled eyes (81.43%) got cured i.e. 32/39 eyes (82.05%) were successful in the canalicular upper obstruction group, and 25/31 eyes (80.65%) in the duct lower obstruction group.Conclusion KTP laser therapy combined with silicone intubation as an effective alternative to treat both common canalicular obstruction and nasolacrimal duct obstruction is recommended as the first choice. Key words： lacrimal duct obstruction laser surgery lacrimal plastic operation silicone intubation 上泪道阻塞（泪小管、泪总管）是传统的泪囊鼻腔吻合术（dacryocystothinostomy, DCR）不能治愈的泪道阻塞，大多数患者都有泪道探通后很快再次阻塞的治疗经过。外路DCR是治疗下泪道鼻泪管阻塞导致的泪囊炎的经典手术，但手术需要切开皮肤、凿除鼻骨，创伤较大。我院自2005年11月—2006年12月采用泪道KTP-Nd: YAG激光（简称KTP激光）成形术联合硅胶管置入治疗泪道阻塞患者67例70眼，其中包括上泪道阻塞39眼，下泪道阻塞31眼，取得了良好的临床效果，现报道如下。 1 资料和方法 1．1 一般资料 2005年11月—2006年12月连续在徐州医学院附属医院眼科门诊就诊的泪道阻塞患者67例70眼，其中男7例9眼，女60例61眼；年龄22～78岁，平均52.68岁；病程5个月～21年。患者在术前均经泪道冲洗、泪道探通或泪道造影等检查确诊，所有患者在术前均行全身检查以排除严重的心脏病变和鼻腔疾病。研究对象中上泪道阻塞39眼，包括泪小点狭窄或闭锁，上、下泪小管阻塞和泪总管阻塞。