KTP激光加泪道插管治疗难治性泪道阻塞

目的　探讨KTP激光加泪道插管治疗难治性泪道阻塞的临床效果。方法　用带针芯的泪道探针插至泪道阻塞处 ,拔出针芯 ,将KTP激光纤维插至泪道阻塞处 ,激发激光将阻塞处疏通 ,再将直径0 6～ 0 8mm硅胶管穿在针芯上 ,插入泪道 ,拔出针芯 ,使硅胶管留置泪道内 8～ 10周。结果　采用此方法治疗各种难治性泪道阻塞 31例 32眼 ,其中 2 7例 2 8眼治愈 ,4例 4眼无效 ,治愈率 87 5 %。结论　KTP激光加泪道插管是治疗难治性泪道阻塞的有效方法。     

KTP∶YAG激光行泪道疏通手术及围手术期的疗效和护理

目的总结KTP∶YAG激光泪道疏通术的疗效和优点,以及围手术期的护理方法。方法泪道阻塞患者135例(142只眼),病程3个月至30年。用带芯的泪道探针探查泪道阻塞处,拔出针芯,插入KTP∶YAG激光导光纤维,发射激光(功率1000mW/cm2,频率3~5KHz,光斑直径0·4mm),清除阻塞,疏通泪道,治疗的同时认真做好术前、术中和术后护理。结果随访3~6个月,治愈121只眼(85·2%),有效13只眼(9·2%),无效8只眼(5·6%);其中,36只眼行第二次激光手术。结论KTP∶YAG激光泪道疏通术操作,简单、准确、时间短、创伤小;可治疗各类型的泪道阻塞。规范的围手术期治疗与护理是治疗成功的必要条件,泪道阻塞再次手术仍有较高的治愈率。     

激光泪道成形术治疗难治性先天性鼻泪管阻塞

目的　评价激光泪道成形术治疗难治性先天性鼻泪管阻塞的效果。方法　采用KTP激光泪道成形术对 15例 (15眼 )难治性先天性鼻泪管阻塞患儿进行治疗 ,观察其临床效果。结果　术后随访 6～ 2 4个月 ,治愈率为 93 3% ,无并发症发生。结论　激光泪道成形术能够安全、有效治疗难治性先天性鼻泪管阻塞。     

KTP:YAG激光行泪道疏通手术及围手术期的疗效和护理

目的总结KTP:YAG激光泪道疏通术的疗效和优点,以及围手术期的护理方法.方法泪道阻塞患者135例(142只眼),病程3个月至30年.用带芯的泪道探针探查泪道阻塞处,拔出针芯,插入KTP:YAG激光导光纤维,发射激光(功率1 000 mW/cm2,频率3～5 KHz,光斑直径0.4 mm),清除阻塞,疏通泪道,治疗的同时认真做好术前、术中和术后护理.结果随访3～6个月,治愈121只眼(85.2%),有效13只眼(9.2%),无效8只眼(5.6%);其中,36只眼行第二次激光手术.结论KTP:YAG激光泪道疏通术操作,简单、准确、时间短、创伤小;可治疗各类型的泪道阻塞.规范的围手术期治疗与护理是治疗成功的必要条件,泪道阻塞再次手术仍有较高的治愈率.     

激光泪道成形术治疗滩治性先天性鼻泪管阻塞

目的 评价激光泪道成形术治疗难治性先天性鼻泪管阻塞的效果。方法 采用KTP激光泪道成形术对15例（15眼）难治性先天性鼻泪管阻塞患儿进行治疗，观察其临床效果。结果 术后随访6～24个月，治愈率为93.3%，无并发症发生。结论 激光泪道成形术能够安全、有效治疗难治性先天性鼻泪管阻塞。     

激光泪道成形术联合支架植入治疗慢性泪囊炎

目的：观察激光泪道成形术联合鼻泪管支架植入对慢性泪囊炎的治疗效果。方法：慢性泪囊炎患者61例（69眼），男性5例（5眼），女性56例（64眼）；病程6个月至20年。将特制的空心泪道探针插至泪道阻塞处，从空心插入光导纤维，以功率为8－14W的KTP激光击射阻塞处1－3次。待泪道通畅后从鼻腔逆行置入带有小孔蘑茹头和引流管的鼻泪管支架。术后追踪9－33个月。结果：56眼溢泪完全消失，9眼溢泪减轻，总有效率为94．2％。无并发症发生。结论：激光泪道成形术联合鼻泪管支架植入是治疗慢性泪囊炎安全、有效的方法。     

激光与典必殊眼膏联合治疗泪道阻塞

我们从 1998年 3月至 1999年 5月采用泪道激光与典必殊眼膏联合治疗泪道阻塞 ,经 1年的临床观察 ,收到了良好的效果 ,报告如下。资料与方法1 一般资料　 193例 2 4 1眼均为泪道冲洗不通的泪道阻塞病例。其中男性 2 1例 2 9眼 ,女性 172例 2 12眼 ,右眼泪道阻塞 10 9眼 ,左眼泪道阻塞 10 2眼 ,双眼泪道阻塞 2 4例 ,伴脓性分泌物 30眼。年龄 10～ 72岁 ,病程 5个月至 5 0年。治疗后观察 1年以上。2 术前准备　泪道冲洗 2～ 3次 ,探查泪道阻塞部位 ,并行碘油造影 ,了解泪囊、鼻腔情况。3 手术方法　患者取仰卧位 ,泪小管阻塞者 ,将泪道激光光…     

KTP激光加泪道插管治疗难治性泪道阻塞31例临床研究

难治性泪道阻塞是指泪小管、泪总管及鼻泪管的阻塞已经多方的治疗 ,仍有溢脓及泪道冲洗不通畅者。我院自1999年 9月～ 2 0 0 1年 9月 ,采用ＫＴＰ倍频Ｎｄ :ＹＡＧ激光(以下简称ＫＴＰ激光 )加泪道插管治疗难治性泪道阻塞 3 1例 3 2眼 ,疗效满意 ,现报告如下。1　临床资料1 1　一般资料　 3 1例、3 2眼 ,年龄最小 3 6岁 ,最大 77岁 ;男 13例 ( 14眼 ) ;女 18例 ( 18眼 )。病史最短者 0 5ａ ,最长4 2ａ。1 2　阻塞部位　泪小管合并泪总管阻塞 3例 ( 3眼 ) ,泪总管合并鼻泪管阻塞 6例 ( 6眼 ) ,泪小管、泪总管合并鼻泪管阻塞 7例 ( 7眼 )。泪…     

激光泪道成形术联合丝裂霉素C治疗泪道阻塞

目的 探讨丝裂霉素C（MMC）在Nd：YAG激光泪道成形术中的疗效。 方法 将308例（398只眼）泪道阻塞患者随机分为对照组和治疗组，治疗组158例（210只眼）采用常规激光泪道成形术后将0．2ml丝裂霉素C注入泪道5min后应用抗生素眼膏填充泪道，对照组150例（188只眼）采用常规激光泪道成形术，术毕应用抗生素眼膏填充泪道。 结果 术后随访6～36个月，平均24个月，治疗组治愈率为87．1％，总有效率为95．7％；对照组治愈率为78．2％，总有效率为83．0％。对照组疗效低于治疗组（P〈0．05）。 结论 在泪道激光成形术中应用MMC可有效减少激光术后纤维组织增殖和瘢痕形成，提高远期疗效。     

Nd∶YAG激光泪道成形术联合氧氟沙星膏治疗泪道阻塞

目的 :探讨Ｎｄ∶ＹＡＧ激光泪道成形术联合氧氟沙星膏治疗泪道阻塞的方法和疗效。方法 :本组患者 40例 5 8只眼 ,应用国产Ｎｄ∶ＹＡＧ激光治疗机 ,波长 1 0 6 4μｍ ,脉冲频率 5～ 40Ｈｚ ,输出功率 >3Ｗ ,特制 9号空芯泪道探针 (带针芯 ) ,泪道冲洗针头及氧氟沙星膏。患者仰卧位 ,常规 0 5 %丁卡因滴眼 2次 ,泪小点小者用泪点扩张器扩张泪小点后 ,将带针芯的泪道探针按常规泪道探通法 ,从泪小点缓慢插到泪道阻塞处 ,拔出针芯 ,通过空针引入光导纤维直到泪道阻塞处 ,对阻塞处连续击射 ,至阻力消除有落空感后 ,抽出光导纤维 ,用生理盐水冲…     

KTP激光联合置管治疗泪道阻塞的临床疗效分析

目的探讨KTP激光联合置管治疗泪道阻塞的效果。方法KTP激光联合置管治疗泪道阻塞患者232例250只眼,术后置管放置3个月,拔管后平均随诊2个月。观察泪道功能恢复情况,判断疗效。结果总治愈率为82.5%。泪总管阻塞的治愈率高于泪小管和鼻泪管阻塞,差异有显著意义(P0.05)。泪小管与鼻泪管阻塞治愈率比较差异无显著意义(P0.05)。男女患者各部位阻塞的治愈率差异无显著意义(P0.05)。结论KTP激光联合置管治疗泪道阻塞方法简便,组织损伤小,疗效肯定,对不同阻塞部位的泪道阻塞均有良好的治疗效果。     

Efficacy of mitomycin-C irrigation after balloon dacryocystoplasty

PURPOSE: To evaluate the safety and efficacy of mitomycin-C irrigation after balloon dacryocystoplasty in the treatment of epiphora caused by obstruction of the lacrimal system. MATERIALS AND METHODS: Thirty-five lacrimal systems in 33 patients with obstruction of the lacrimal system were assigned to one of two groups: 17 lacrimal systems were irrigated with mitomycin-C after balloon dacryocystoplasty (mytomycin-C group), and 18 were not irrigated with mitomycin-C after balloon dacryocystoplasty (non-mitomycin-C group). In the mitomycin-C group, the lacrimal systems were irrigated with 0.2 mg/mL mitomycin-C via the inferior lacrimal punctum in three different sessions: immediately, 1 week, and 1 month after balloon dacryocystoplasty. The cumulative patency rates after balloon dacryocystoplasty were calculated by using the Kaplan-Meier method and were compared between the two groups with use of the log-rank test. RESULTS: Balloon dacryocystoplasty and subsequent mitomycin-C irrigation were technically successful in all lacrimal systems. There were no side effects or complications associated with mitomycin-C use. The cumulative patency rate in the mitomycin-C group was significantly higher than that in the non-mitomycin-C group after balloon dacryocystoplasty (P = .0150, log-rank test). CONCLUSIONS: Mitomycin-C irrigation is safe and effective in increasing the patency rate of the lacrimal system after balloon dacryocystoplasty.     

综合治疗先天性泪道阻塞133例临床分析

目的：观察综合疗法治疗先天性泪道阻塞的临床疗效。方法选133例147眼先天性泪道阻塞患儿行泪囊按摩,泪道加压冲洗无效即予一体式泪道空心探通针进行泪道探通术,观察治疗的情况进行分析。结果行泪囊按摩方法治愈17只眼,治愈率为11.56%;泪道加压冲洗法治愈25只眼,治愈率17.00%;泪道探通法治愈99只眼,治愈率67.35%;无效6只眼,占4.08%。结论泪囊按摩法和泪道冲洗法治疗新生儿泪道阻塞简单易行有效。泪道探通术是治疗先天性泪道阻塞最有效的方法之一。     

鼻泪管阻塞的内涵管治疗

目的介绍鼻泪管阻塞的内涵管治疗。方法对9例11只鼻泪管阻塞（鼻泪管与泪囊连接处）置放Song601型内涵管治疗，按Song方法顺行引入导丝，逆行放入内涵管。术前与术后做泪囊造影。结果所有鼻泪管在术后造影均通畅，最长随访日为377天，放内涵管前，所有病例均有Ⅳ～Ⅴ度流泪程度，放内涵管后半年内，10只（91％）流泪明显好转，其中7只完全正常；1只5个月后无效，取出内涵管重新置放，症状消失至今3个月。结论介入治疗界泪管阻塞是一种安全、简单及有效的方法，不影响局部解剖结构。     

Naso-lacrimal duct balloon dilatation: medium to long term follow-up

AIM: Subjective patient response to nasolacrimal duct balloon dilatation (dacryocystoplasty) for epiphora due to primary acquired nasolacrimal duct obstruction (PANDO), was sought over the medium to long term. The relevant dacryocystograms were reviewed to assess the relationship between treatment outcome and dacryocystographic appearances. MATERIALS AND METHODS: Sixty-three patients who had, in the preceding 12-month to 8-year period, undergone 102 dacryocystoplasties were sent a postal questionnaire in which subjective response to treatment was requested. Fifty-seven original dacryocystograms were reviewed by the author and the appearances of the lacrimal sacs subjectively assessed. RESULTS: The results showed that in 31% of respondents (total response 48/63, 76%) dacryocystoplasty was ineffective for treatment of PANDO. Treatment failures did not respond to repeat treatment. Sixty-nine per cent of patients considered themselves either cured or improved by the treatment, with a minimal relapse rate during the period studied. The original dacryocystoplasty appearances were unhelpful in predicting treatment response. CONCLUSION: Dacryocystoplasty can be expected to relieve or improve epiphora in 69% patients with PANDO, (incomplete obstruction) and favourable response to treatment is durable in the medium to long term. Repeat treatment is not recommended for those who fail to respond, though may be appropriate for cases of temporary response. The technique is safe and well tolerated. McCullough, K. M. (2001). Clinical Radiology56, 13-16.     

Die Bedeutung bildgebender Diagnostik und interventioneller Therapie bei Erkrankungen der ableitenden Tränenwege

Epiphora (continuous watering of the eyes) is frequently caused by obstruction of the lacrimal draining system. Radiographic imaging of the tear ducts after contrast injection with the DSA (digital subtraction angiography) dacryocystography technique is still the gold standard in patients with severe epiphora which does not respond to conservative therapy. Recent techniques, such as 3D rotational dacryocystography, MRI and CT are able to show the anatomic surroundings in addition to the ductal structures and are especially useful for planning endoscopic operations. Dacryocystographically assisted interventions, such as balloon dilatation or stenting of tear duct stenoses are technically feasible. Balloon dacryocystoplasty is especially successful in patients with incomplete or short distance obstructions of the nasolacrimal duct. Stenting may improve procedural success and patency rates. Minimally invasive interventional therapy is useful as an initial treatment in selected cases, however, long-term success rates may be limited and operative dacryocystorhinostomy still plays an important role. Comparative studies for evaluation of different therapeutic options are necessary.     

Nd:YAG激光泪道成形术联合丝裂霉素C治疗泪道阻塞疗效评价

目的评价Nd:YAG激光泪道成形术联合丝裂霉素C治疗泪道阻塞的效果。方法 Nd:YAG泪道激光成形术联合丝裂霉素C治疗192例218只眼,丝裂霉素C浓度为0.4mg/ml、泪道内浸润时间2min。术后随访观察3～36个月泪道引流的恢复情况和有无丝裂霉素C的不良反应。结果总治愈193只眼(88.5%),3只眼出现下泪点撕裂,随访对导泪无影响,无丝裂霉素C不良反应和并发症发生。结论 Nd:YAG激光泪道成形术联合丝裂霉素C治疗泪道阻塞安全有效,MMC局部发挥抗增殖抗瘢痕作用,可有效提高手术成功率。     

Lacrimal scintigraphy in the diagnosis of epiphora.

The value of lacrimal scintigraphy in the assessment of nasolacrimal duct obstruction was determined by comparing the results with syringing in 67 patients (83 eyes). As expected, of 28 lacrimal drainage systems which were obstructed on syringing, 23 (82%) had abnormalities of tear drainage on scintigraphy. However, in 55 lacrimal drainage systems that were patent on syringing, 19 (35%) were normal, but in 36 (65%) abnormalities not apparent on syringing were detected on scintigraphy. Thus scintigraphy is a very useful technique in the assessment of nasolacrimal duct obstruction particularly in systems patent on syringing. Since the site of obstruction can be determined, lacrimal scintigraphy can facilitate the planning of the appropriate surgery.     

Congenital lacrimal system obstruction: treatment with balloon dilation

PURPOSE: To evaluate the safety and effectiveness of balloon dilation for the treatment of congenital lacrimal system obstruction. MATERIALS AND METHODS: Fluoroscopically guided balloon dilation was attempted in 20 eyes of 16 patients with an age range of 12-78 months (mean, 33 mo) for congenital lacrimal system obstruction. Fifteen eyes had complete obstruction at the valve of Hasner, three eyes had completely obstruction at the junction between the lacrimal sac and the nasolacrimal duct, and two eyes had partial obstruction at the nasolacrimal duct. Under general anesthesia, a ball-tipped guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and pulled out through the naris with use of a hook. A deflated 3-mm-diameter balloon catheter was then advanced in a retrograde direction and the balloon was dilated. Every patient underwent an ophthalmic evaluation before the procedure and was scheduled to be followed with office examination at 1, 3, and 6 months after the procedure. RESULTS: There were no major complications. "Technical success" was defined as free passage of contrast medium through the entire lacrimal system to the nasal cavity. The procedure failed in one eye. After balloon dilation, all 19 eyes in which technical success was achieved showed improvement of epiphora. During the follow-up period of 2-33 months (mean, 16 mo), all eyes maintained improvement of epiphora and needed no further treatment. CONCLUSION: Balloon dilation is a safe and effective therapeutic technique for the treatment of congenital lacrimal system obstruction.     

Balloon dacryocystoplasty: results and factors influencing outcome in 350 patients

PURPOSE: To evaluate the initial and long-term results of balloon dacryocystoplasty in the treatment of epiphora caused by obstruction of the lacrimal system with analysis of the procedure's favorable effects. MATERIALS AND METHODS: Four hundred thirty eyes of 350 patients with obstructions of the lacrimal system were enrolled. Dacryocystoplasty was performed with use of a balloon catheter and a ball-tipped guide wire. The lesions were categorized according to cause, severity, site of the obstruction, and diameter and inflation time of the balloon. The technical success, initial success (improvement of symptoms after 1 week), and long-term patency rates were calculated. These rates in each group were compared with the chi(2) test and the Kaplan-Meier method. RESULTS: The overall technical success rate was 95.3%. The overall initial success rate was 57.4%. There was no significant complication except for mild epistaxis in 12%. The 2-month, 1-year, and 5-year patency rates were 48.2%, 39.4%, and 36.9%, respectively. Initial success was influenced by the severity (P =.014) and the site (P <.001) of the obstruction, and the diameter of the balloon (P =.047). Long-term patency was affected by the site of the obstruction (P <.001) and the balloon inflation time (P <.001). Among the 183 initially ineffective and 88 recurrent cases, 62 underwent repeat balloon dacryocystoplasty, and the initial success rate was 38.7%. CONCLUSIONS: The initial success rate of balloon dacryocystoplasty is relatively low. However, long-term patency can be expected in cases with initial success. Some additional factors also should be considered for better results.