不同部位阻塞性泪道疾病激光泪道成形术疗效观察.docVIP

不同部位阻塞性泪道疾病激光泪道成形术疗效观察 【摘要】nbsp; 　　目的：比较KTP激光泪道成形术治疗不同部位阻塞性泪道疾病的远期疗效。方法：阻塞性泪道疾病共587眼，根据阻塞部位的不同分组，激光泪道成形术后均连续使用易妥芬眼液冲洗泪道，对比分析各组远期疗效。结果：KTP泪道激光在泪道阻塞性疾病的治疗中不同阻塞部位的疗效间存在差异，下泪小点、泪小(总)管阻塞组的治疗有效率高于单纯鼻泪管阻塞及慢性泪囊炎组。结论：KTP泪道激光对泪小点、泪小(总)管阻塞效果很好，对单纯鼻泪管阻塞的病例也有一定的疗效，但是在慢性泪囊炎的病例中复发率较高。对于长期慢性泪囊炎的患者，我们建议选择泪囊鼻腔吻合术。 【关键词】nbsp; 泪道阻塞；慢性泪囊炎；激光 　　Therapeutic efficacy of KTP laser assisted dacryocystoplasty for lacrimal duct obstruction nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; Abstractnbsp; AIM: To evaluate the therapeutic efficacy of KTP laser assisted dacryocystoplasty for lacrimal duct obstruction.nbsp; METHODS: The lacrimal obstruction ducts in a total of 587 eyes were chosen and were separated into 4 groups. KTP laser fibers were inserted into the lacrimal ducts to dredge the obstructed parts by laser. Instillation of same drugs was used after operation.nbsp; RESULTS: The cure rate, improvement rate, and ineffectiveness rate were different among 4 groups. The difference between 4 groups was significant. CONCLUSION: KTP laser assisted dacryocystoplasty can better used in a certain part of lacrimal duct obstruction. But the cure rate in chronic dacryocystitis cases is not the same as others. nbsp;nbsp;nbsp; ?KEYWORDS: obstruction of lacrimalduct; chronic dacryocystitis; lasers 　　0引言 nbsp;nbsp;nbsp; 泪道阻塞是一类常见眼病,我们从2003-11/2006-06应用KTP激光治疗不同部位的阻塞性泪道疾病，选取术后相同处理方法并完成随访的587例587眼，总结如下。 nbsp;nbsp;nbsp; 1对象和方法 nbsp;nbsp;nbsp; 1.1对象 阻塞性泪道疾病共587例587眼，年龄7～83岁，病程2mo～30a。所有病例的激光治疗均由同一医生完成。器械设备：带导光纤维(0.3～0.6mm)的KTP激光治疗机(武汉华中理工大学)，波长532nm，脉冲频率3 000～5 000ps，功率8～15W可调，自制泪道探针(带针芯)，自制泪道冲洗针头。 nbsp;nbsp;nbsp; 1.2方法 常规泪道冲洗，粘膜表面麻醉，扩张下泪小点。将带针芯的泪道探针从下泪小点插入至泪道阻塞处，拔出针芯，通过空针引入导光纤维，调整激光能量与频率对阻塞处作连续击射至阻力消除并有落空感。抽出光纤，用生理盐水冲洗，若泪道冲洗通畅，则用带侧孔的泪道冲洗针头向泪道注入易妥芬眼液（主要成分庆大霉素1.5万U，10g/L氟美松龙）。本组病例术后均用易妥芬眼液冲洗泪道，术后3～5d每日连续冲洗，后每周冲洗1～2次。所有病例定期随访，平均随访1.5a。疗效判定：术后溢泪消失，泪道冲洗通畅为治愈；术后溢泪症状缓解，需定期冲洗，冲洗通畅者为好转，以上均为有效；术后仍溢泪、溢脓，冲洗不通和（或）有粘性分泌物返流为无效。 nbsp;nbsp;nbsp; 2结果 nbsp;nbsp;nbsp; KTP泪道激光在泪道阻塞性疾病