泪道旁路手术的适应证及手术方式

目的探讨泪道旁路手术的手术适应证及手术方式的选择。方法对131例（152只眼）泪道旁路手术进行综合分析。患者采用了唇黏膜桥泪道旁路结膜泪囊鼻腔吻合术和玻璃义管泪道旁路结膜泪囊鼻腔吻合术两种手术方式,对术前检查结果、手术后效果、术后并发症及患者满意程度进行统计分析。结果唇黏膜桥泪道旁路手术15例（19只眼）,玻璃义管泪道旁路手术116例（133只眼）。两组泪道阻塞溢泪症状明显,109例（130眼）为泪小管阻塞,泪小管残留部〈10mm。另有22例（22眼）为外伤导致内眦部畸形、眶内壁骨折伴发的泪道阻塞。术后唇黏膜桥泪道旁路手术组出现2例（2只眼,占13．33％）复发,玻璃义管泪道旁路手术组出现18例（19只眼,占16．38％）复发,术后并发症主要表现为吻合口瘢痕增生、肉芽组织增生,术后干眼,眼部不适感等。结论泪道旁路手术是解决泪道阻塞疾病的有效手段,唇黏膜桥泪道旁路手术和玻璃义管泪道旁路手术都是可选择的有效的治疗方式,相比较后者更易于临床开展;对于外伤导致的内眦部畸形、眶内壁骨折伴发的泪道阻塞,可以选择玻璃义管泪道旁路手术;泪小管阻塞合并泪囊炎患者行泪囊摘除令并以上两种泪道旁路手术可以获得良好效果。     

人工泪道植入术治疗陈旧性泪小管离断和泪囊摘除术后溢泪临床初探

目的 探讨和评价硅胶管人工泪道植入术后的临床疗效。方法 采用软性硅胶管人工泪道从鼻腔鼻前庭骨性鼻腔的侧壁经上颌窦鼻侧表面软组织下植入至泪点下睑穹隆部结膜，缝线固定人工泪道。结果 陈旧性泪小管离断伤2例（2眼），泪囊摘除术后3例（3眼），植入术后临床跟踪观察6个月，溢泪症状消失，结膜囊及眼部无刺激症状和不适感，均达到治愈标准。结论 软性硅胶管人工泪道植入术是治疗陈旧性泪小管离断伤和泪囊摘除术后溢泪症状的有效、方便的术式。术后相关问题有待探讨。     

泪道激光成形术的疗效观察

目的 探讨泪道激光成形加留置导管术治疗泪道阻塞的疗效。方法 选择泪小管、泪总管、鼻泪管阻塞泪溢者223例(267只眼)，在结膜囊表面麻醉下，行泪道激光成形加留置导管术，1月后拔管，连续冲洗泪道7天。结果 治愈248只眼(92．88％)，有效8只眼(3．00％)，无效11只限(4．12％)。结论 泪道激光成形加留置导管术是治疗泪道阻塞的可靠方法。     

Medpor泪道义管植入术治疗难治性泪道阻塞的临床分析

目的探讨Medpor泪道义管植入术治疗难治性泪道阻塞的有效性和安全性,指导临床应用。方法于2010年3月至2015年3月在武汉爱尔眼科医院就诊的55例难治性泪道阻塞患者作为研究对象,对其中46例泪囊存在患者行鼻内镜下结膜囊泪囊鼻腔吻合联合Medpor泪道义管植入术,对另外9例无泪囊患者行单纯Medpor泪道义管植入术。术后随访3～60个月,通过临床资料收集、门诊随访和电话随访相结合的方法,记录患者泪道阻塞类型及手术方式,观察手术效果和并发症情况,对数据结果进行分析,评价Medpor泪道义管植入术的临床意义。结果51例（92．7％）患者无溢泪症状或溢泪症状明显改善,义管管内冲洗通畅。术后并发症包括：义管上下口肉芽组织增生9例（16．4％）,异物不适感8例（14．5％）,义管管腔被分泌物阻塞5例（9．1％）,义管长度不当2例（3．6％）,义管反复移位2例（3．6％）。结论Medpor泪道义管植入术可有效治疗难治性泪道阻塞。手术方法成功率高,并发症少,安全有效,值得临床推广。     

泪道激光联合改良结膜松弛矫正术治疗溢泪

目的探讨泪道阻塞合并结膜松弛引起的溢泪,行泪道激光联合改良结膜松弛矫正术的临床效果。方法2011年10月至2012年10月在天津爱尔眼科医院行泪道激光联合改良结膜松弛矫正术28例（42眼）。分析其治疗溢泪的临床效果、并发症及其手术要点,并与分期手术进行对比。结果42眼中治愈6眼,明显好转25眼,好转10眼,无效1眼,总有效率为97．6％。并发症包括泪道阻塞复发15眼,但其中14眼溢泪症状亦明显改善;治愈病例中有2眼出现轻度干眼。手术效果与分期手术者无明显差异。结论泪道激光联合改良结膜松弛矫正术治疗溢泪有效,术后并发症少。改良结膜松弛矫正术的手术要点是处理眼球筋膜囊,并将其与浅层巩膜固定。     

高密度多孔聚乙烯包裹玻璃管植入泪道旁路术的临床分析

目的探讨高密度多孔聚乙烯（HDPP）包裹玻璃管植入泪道旁路术的有效性和安全性。方法溢泪症状明显且无法再通泪道患者26例（26只眼）,其中10例泪小点和泪管缺失、泪囊存在患者行结膜鼻腔泪囊吻合联合HDPP包裹玻璃管植入泪道旁路术,16例泪小点和泪管缺失且无泪囊患者行单纯HDPP包裹玻璃管植入泪道旁路术。术后随访4—28个月,记录手术适应证、手术方式及其成功率,观察手术并发症的发生情况,对数据结果进行分析。结果术后患者溢泪症状消失或明显改善,义管冲洗通畅者23例（88．5％）,对手术结果满意者21例（80．8％）,无义管排出或严重移位者。术后并发症包括义管阻塞9例（手术再通8例）、不适感4例、义管长度不当2例、义管位置不当1例、感染1例,复视1例,角膜上皮损伤1例、鼻腔分泌物反流1例。结论HDPP包裹玻璃管植入泪道旁路术可有效解决泪道无法再通患者的溢泪症状,手术成功率较高,手术安全、有效。     

Nd：YAG激光治疗泪道阻塞134例

目的：探讨国产泪道激光机治疗泪道阻塞的临床价值。方法：采用国产Nd:YAG泪道激光机治疗各种原因所致的泪道阻塞134例148例，结果：148眼中，治愈（溢泪症状消失，泪道术洗通畅）113眼占76．4％，好转（溢泪症状减轻，泪道术洗通而不畅）8眼占5．4％，无效27眼占18．2％，失败病例为慢性泪囊炎19眼，单纯性鼻泪管阻塞3眼，泪小管阻塞5眼，其中3眼形成假道，结论：国产Nd:YAG激光治疗泪道阻塞具有操作简便，组织损伤小，极小出血等优点，尤其是泪小管阻塞，传统的各种手术方法操作难度大，成功率低，而激光治疗相对简便，在表麻下完成，且治愈率也较高，但慢性泪囊炎行激光治疗效果不理想。     

下结膜囊上颌窦穿刺泪道重建术10例

关于泪道重建的方法有泪囊鼻腔吻合术等，但泪小管闭锁的泪道再造是棘手难题。作者以偶然的机会发现眶下壁骨折下结膜囊与上颌窦痕者达到了泪道改道之效；从而进一步研究，对1例泪小管瘤痕闭锁者行下结膜囊上颌窦穿刺，导管留置，新泪管形成术。方法简便易行，现介绍如下。1资料与方法1．1一般资料本组10例，其中男7例，女3例。外伤性泪小管断裂痕痕闭锁2例；外伤性摊痕睑外翻2例；慢性泪囊炎5例；泪囊鼻腔吻合术未成功者1例。典型病例：患者，男，43a。因采石头时，头部碰到石尖上，右眼内毗部外伤，在乡镇医院缝合治疗后遗有溢泪症。1996…     

探通术加四环素可的松眼膏联合治疗泪道阻塞

目的：探讨机械疏通联合应用四环素可的松眼膏留置泪道治疗泪道塞的疗效。方法：常规方法下对17例17眼泪道阻塞（主要是泪囊至鼻泪管处阻塞／狭窄,以下简称下段泪道阻塞／狭窄）行探通术,留针20分钟后边退空心针、边向泪道内注入四环素可的松眼膏。结果12例溢泪消失,冲睛道通畅为治愈（占70．6％）;2例轻度泪溢、冲洗泪道稍有阻力为有效（占（11．8％）,3例仍溢泪、冲洗泪道不通为无效（占17．6％）。结论泪道探通术联合应用四环素可的松眼膏治疗泪道阻塞总有效率达82．4％。应用探通术加四环素可的松眼膏留置泪道是治疗下段泪道塞的有效方法。     

避孕环在鼻泪管阻塞钻切术中的应用

本科自1993年以来,利用自制钻切器,行鼻泪管阻塞钻切术,用金属避孕环做鼻泪管支撑义管.30例36眼单纯鼻泪管阻塞或合并慢性泪囊炎患者,取得良好效果,报告如下.一般资料:30例36眼均为不伴有泪小点及泪小管异常的鼻泪管阻塞或泪囊炎患者.其中男6例,女24例.年龄15～45岁,平均29岁.病程6～96月,平均18月.右眼21眼,左眼15眼,双眼6例.常规检查:出凝血时间、鼻腔检查、泪道冲洗探通、泪道X线造影、泪道B超检查(除外肿瘤),术后染色试验.手术器械:用10～12号锁骨下静脉穿刺针,头端磨成平刃钻切器,将钻切刃上端30mm处弯成20°.取医用金属避孕环折成长约30mm,一端呈喇叭形的钢丝义管备用.手术方法:消毒、麻醉和皮肤切口同常规泪囊手术,但切口全长仅10mm.钝性分离暴露内眦韧带下缘.沿前泪嵴鼻侧1mm处切开骨膜,用骨膜剥离器向泪囊窝方向分离.在泪囊前内     

Conjunctivodacryocystorhinostomy with Jones tube

One hundred and eight patients (111 eyes) underwent conjunctivodacryocystorhinostomy with a Jones tube for treatment of epiphora resulting from canalicular obstruction. Sixty-nine patients (63.9%) were females and thirty-nine (36.1%) were males. Their ages ranged from 9 to 64 years, the mean age being 30.1 years. The causes of lacrimal drainage abnormalities included idiopathy (76 cases, 68.5%), trauma (15 cases 13.5%), tumors (8 cases, 7.2%) congenital abnormalities (6 cases, 5.4%) and conjunctival inflammation (6 cases, 5.4%). Twenty-eight (36.8%) eyes in the idiopathic group had previous failed dacryocystorhinostomies. The operation was successful in 90.1% of the eyes with relief of epiphora. Fifty-one out of 111 (45.9%) eyes had complications. Extrusion of the tube was the most frequent complication occurring in 20 (18%) eyes. Malposition (12 eyes 10.8%), infection (12 eyes, 10.8%) and obstruction of the tube (7 eyes, 6.3%) were the other major complications. Of the 20 eyes with tube extrusion, 11 experienced recurrent tube losses. Five of 11 eyes were free of epiphora after tube loss. Four out of five had the tube in place for 2 to 5 years and one had the tube, in place for one year. The remaining 6 eyes which had the tubes for 6 months to 3 years were complicated by epiphora. Our experience confirms the general belief that the tube should stay in place forever. The large majority of our patients could wear their tubes successfully and have done so in our practice for as long as 10 years.     

球头硅胶管逆行植入术治疗慢性泪囊炎的效果

目的  观察鼻泪管球头硅胶管逆行植入术治疗慢性泪囊炎的临床疗效。设计  回顾性病例系列。研究对象 65 例（67眼）慢性泪囊炎患者。方法  对以上患者行鼻泪管球头硅胶管逆行植入术,采用泪道探通的方法,8号送线针将牵引线送入下鼻道,鼻泪管扩张绳扩张鼻泪管后,在牵引线的引导下逆行植入球头硅胶管。术后1周内每天以冲洗液（庆大霉素+地塞米松混合液及生理盐水）冲洗泪道 1 次,1周后改为每周冲洗泪道1次,持续3个月。3～6个月后拔出球头硅胶管,拔管后每周以冲洗液冲洗泪道,共4次,鼻泪管内注入妥布霉素地塞米松眼膏。随访 3个月～2年,观察泪道是否通畅及分泌物情况。主要指标 溢泪流脓症状、泪道冲洗结果。结果 术中65例（67眼）均一次植管成功,泪道冲洗通畅,拔管后随访期间49眼（73.13%）泪道冲洗通畅,泪溢及脓性分泌物消失。术中及术后无明显并发症,无假道形成。结论 球头硅胶管逆行植入术对大部分慢性泪囊炎患者治疗有效。（眼科, 2014, 23： 126-129）     

Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy

AIM: To investigate the effect of bicanalicular silicone tube intubation (BSTI) in the treatment of functional epiphora after endoscopic dacryocystorhinostomy (En-DCR). METHODS: Clinical data of 84 patients (95 eyes) with functional epiphora after En-DCR were retrospectively analyzed. Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test (FDDT), lacrimal irrigation test, as well as endoscopic examination. Secondary BSTIs were recommended for patients with functional epiphora. These tubes were removed 1mo after surgery. Functional success and associated complications were assessed after 2y of follow-up. RESULTS: Seven patients (9 eyes) refused intervention, 5 patients (6 eyes) did not complete postoperative follow-up, and 1 patient (1 eye) developed tube prolapse within 1mo after surgery. Seventy-one patients (79 eyes) were included at last. Functional success ratios at six months, one year, as well as two years post-operation were 94.9% (75/79), 92.4% (73/79), and 91.1% (72/79), respectively. Three eyes presented with punctal slitting (2 eyes without epiphora), 1 eye with proximal canaliculus slitting, 1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up. CONCLUSION: Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR. Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.     

Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction

AIM: To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS: A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS: Thirty-seven adult patients (37 eyes) underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%), with symptoms improving significantly. Two eyes (5.4%) were relieved of indoor epiphora, two (5.4%) had minimal epiphora outdoors, but only with wind or cold, and five (13.5%) continued to experience tearing both indoors and outdoors. Thirty of the patients (81%) expressed satisfaction with the procedure. CONCLUSION: Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.     

泪道激光成形联合置管术治疗复发性泪道阻塞疗效观察

目的 探讨Nd:YAG激光泪道成形术,联合泪道置管治疗复发性泪道阻塞的临床疗效.方法 对76例(91只眼)复发性泪道阻塞采用Nd:YAG激光治疗,并泪道置管3个月,术后定期冲洗泪道.结果 随访6～24月,治愈65只眼,占71.4%;好转11只眼,占12.1%,总有效率83.5%.无效15只眼,占16.5%.结论 Nd:YAG激光泪道成形术联合泪道置管治疗复发性泪道阻塞效果好,并发症少,操作简单,值得推广应用.     

泪小点引流联合泪道激光置管治疗急性泪囊炎并发脓肿

目的：：观察泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术治疗急性泪囊炎并发泪囊脓肿的疗效。方法：对2011-12/2014-12在本院眼科就诊的28例急性泪囊炎并发脓肿患者行泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术,置管6 mo后拔管后再随访6mo,观察流泪、流脓、脓肿消退、泪道通畅等情况及有无并发症发生。结果：各种急性泪囊炎并发脓肿患者在带管6 mo内,脓肿均消退,溢泪消失或改善,泪道冲洗畅。拔管后随访6mo,治愈13眼,好转7眼,总有效率为71%,无效8眼(29%)。结论：泪小点引流联合Nd：YAG泪道激光成形加泪道再通管置入术是一种有效的急性泪囊炎并发泪囊脓肿的治疗方法,但复发率高,可再次手术。     

类Y型硅胶管逆行植入术治疗泪道阻塞

目的:观察类Y型硅胶管逆行置入术治疗泪道阻塞疾病的临床效果。方法:对380例428眼泪道阻塞患者,行类Y胶管支架逆行置管术,随访4wk～6mo,观察其疗效。结果:380例428眼患者取管当日泪道冲洗全部通畅,溢泪症状明显改善或消失。随访342例388眼4wk～6mo,治愈率90.7%,有效率98.7%,复发率1.3%。结论:类Y型硅胶管逆行置管术治疗泪道阻塞是一种简单、经济、安全、有效的治疗方法。     

Effect of short-duration silicone intubation in congenital nasolacrimal duct obstruction

PURPOSE: To determine the incidence of premature dislocation of silicone tubes used in the treatment of congenital nasolacrimal duct obstruction and investigate the effect of early dislocation on treatment outcome. METHODS: This retrospective review of 227 cases of silicone intubation in the treatment of 151 patients with congenital nasolacrimal duct obstruction. Specific attention was given to premature tube displacement, persistent epiphora, and the need for reoperation. The effect of the duration of silicone intubation and patient age on surgical outcome was assessed. Significance was determined using a Mantel-Haenszel chi-square test. RESULTS: Tube displacement and removal prior to postoperative day 31 occurred in 93 of 227 (41%) of eyes. Four of 24 eyes (17%) in children younger than 12 months who had premature dislocation of silicone tubes compared with 7 of 40 eyes (18%) that maintained silicone tubes for 31 days or greater had persistent epiphora (p = 0.932); in eyes of children from age 12 months to 23 months, 5 of 46 (11%) had persistent epiphora compared with 6 of 78 (8%) (p = 0.549); and in children age 24 months or older, 9 of 23 (39%) eyes had tearing compared with 3 of 16 (19%) (p = 0.181). Reoperation rates were 1 of 24 (4%) compared with 0 of 40 (0%) (p = 0.23) of eyes in children younger than 12 months; no difference between groups (0%) in children from age 12 months to 23 months; and 5 of 23 (22%) versus 0 of 16 (0%) (p = 0.049) of eyes in children age 24 months or older for early tube removal versus standard tube removal, respectively. CONCLUSION: Premature tube displacement and tube removal prior to day 31 does not increase the risk of persistent epiphora or reoperation in children younger than 24 months. Children older than 24 months who have early tube removal have poorer outcomes with a significantly higher reoperation rate.