探针式泪道冲洗针治疗婴幼儿先天性鼻泪管阻塞

目的观察探针式泪道冲洗针治疗婴幼儿先天性鼻泪管阻塞的临床疗效。方法对83例（86眼）先天性鼻泪管阻塞的婴幼儿用探针式泪道冲洗针冲洗探通治疗进行观察分析。结果83例（86眼）先天性鼻泪管阻塞，全部探通治愈，其中1次探通治愈78眼（90．70％），2次探通治愈6眼（6．98％），3次探通治愈2眼（2．32％）。无1例出现假道或下泪点撕裂，无并发急性泪囊炎。结论厢探针式泪道冲洗针冲洗探通治疗先天性鼻泪管阻塞是有效的方法。     

两种泪道探通冲洗术治疗先天性鼻泪管阻塞的疗效比较

目的:比较改良的冲洗式泪道探通术与泪道探通冲洗一体式治疗先天性鼻泪管阻塞的治疗效果。方法:选取2008-07/2012-09在我院门诊就诊的252例273眼先天性鼻泪管阻塞的患儿,作为本次的观察对象;其中140例156眼行改良的冲洗式泪道探通,112例117眼行泪道探通冲洗一体式治疗,比较两种方法的治疗效果,并随访1wk～1mo。结果:改良冲洗式泪道探通术一次性探通成功152眼,术后随访有2眼再次阻塞;泪道探通冲洗一体式一次性探通成功107眼,术后随访有8眼再次阻塞;两组比较差异明显具有统计学意义(P<0.05)。结论:改良的冲洗式泪道探通术对先天性鼻泪管阻塞的治疗效果明显优于泪道探通冲洗一体式。     

婴幼儿先天性鼻泪管阻塞的综合治疗

目的探讨应用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术综合治疗婴幼儿先天性鼻泪管阻塞的临床应用价值及治疗效果.方法回顾自2000年11月～2005年5月在我院眼科门诊治疗的382例(419眼)婴幼儿先天性鼻泪管阻塞的病历资料,首诊年龄3d～6y.根据患者年龄和症状分别采用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术的综合治疗进行处理,并随访6个月以上.以无泪溢,眼无分泌物,泪道冲洗通畅或极少返流为治愈标准.结果综合治疗治愈率97.1%,其中5.5%为抗生素眼液滴眼加泪囊区按摩法治愈,11.2%为泪道加压冲洗法治愈,80.4%鼻泪管探通术治愈.2.9%的病例未愈,2.3%病例发生并发症.结论综合治疗婴幼儿先天性鼻泪管阻塞是行之有效且风险较小的一种治疗方法.(中国眼耳鼻喉科杂志,2006,6:97～98)     

先天性鼻泪管阻塞泪道探通最佳时机的探讨

目的评估先天性鼻泪管阻塞最佳手术探通时机。方法随机选择眼科门诊2009年1月至2010年9月1057例(1232只眼)先天性鼻泪管阻塞病例。根据年龄分为A组(<1个月),B组(1～3个月),C组(3～6个月),D组(≥6个月)4组进行观察,所有患儿均在局麻下采用泪道冲洗探通针一次性完成泪道探通手术,手术前后使用生理盐水行泪道冲洗1～2 d,术后予妥布霉素滴眼液滴眼,对于术后泪道不通患儿手术1周复行泪道再次探通,2次探通失败者手术后1个月后再行泪道探通术。治愈标准为无溢泪,无分泌物,泪道冲洗通畅。术后仍然流泪,伴分泌物,泪道冲洗不畅为无效。结果 A组、B组、C组、D组1次治愈率分别为100%、93.3%、82.6%、66.7%,4组比较,患儿年龄越小,手术探通治愈率越高,差异有统计学意义(P<0.01)。结论先天性鼻泪管阻塞,年龄越小手术治愈率越高,出生后3个月内为最佳探通治疗时机。     

自制冲洗探针治疗婴幼儿鼻泪管阻塞416例

目的：评价自制冲洗探针进行探洗术在婴幼儿鼻泪管阻塞中的治疗效果。方法：416例（492眼）婴幼儿鼻泪管阻塞采用泪道加压冲洗并直接探通术治疗，对其疗效进行回顾性分析。结果：416例492眼中一次治愈397眼，占80．69％；二次治愈76眼，占15．45％；三次治愈16眼，占3．25％；无效3眼，占0．61％。观察半年以上均未复发且无并发症发生。总治愈率99．39％。结论：自制冲洗探针治疗婴幼儿鼻泪管阻塞是一种简便、安全、实用、有效的治疗方法。     

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。     

先天性鼻泪管阻塞的临床特点及泪道探通术效果的影响因素

目的：探讨先天性鼻泪管阻塞的临床特点及影响泪道探通术效果的因素。方法：本研究通过回顾性分析2010-06/2011-05在我院眼科就诊并行泪道探通术的先天性鼻泪管阻塞的患儿616例687眼,研究内容包括：初次就诊年龄、泪道探通术时年龄、性别、分娩方式、有无脓性分泌物、既往泪道冲洗和泪道探通术病史。总结其临床特点并通过分析以上各因素与泪道探通术成功率的关系,研究先天性鼻泪管阻塞治疗效果的影响因素。泪道探通术成功的标准为：流泪和眼部分泌物等症状消失,泪道冲洗通畅。结果：剖宫产和自然分娩患儿在泪道探通术成功率方面没有统计学差异（P=0.376）,男女之间也没有统计学差异（P=0.498）。泪道探通术成功率与泪道探通术年龄呈负相关关系（r=-0.328,P=0.001）。3～,6～,9～,12～15,＞15月龄手术成功率分别为：100%,97.8%,90.8%,833%和76.5%。有脓性分泌物的患儿手术成功率明显下降（P=0.013）。患儿既往泪道冲洗病史对泪道探通术成功率影响不大（P=0.561）。但有外院泪道探通术病史的患儿,其手术成功率显著下降（P=0.042）。结论：先天性鼻泪管阻塞的泪道探通术成功率随着年龄的增长而下降,而且脓性分泌物也是泪道探通术失败的危险因素。因此对于先天性鼻泪管阻塞的患儿,有效局部控制炎症和早期行泪道探通术是提高泪道探通术成功率的关键。     

氧氟沙星眼膏在泪道探通术中的应用

目的探讨机械疏通联合应用氧氟沙星眼膏留置泪道治疗泪道阻塞的疗效。方法常规方法下对57例57眼泪道阻塞行探通术，留针15min后向泪道内注入氧氟沙星眼膏。结果42例溢泪消失、冲洗泪道通畅为治愈(73．68％)；6例轻度泪溢、冲洗泪道稍有阻力为好转(10．53％)；9例仍溢泪、冲洗泪道不通为无效(15．79％)。总有效率为8．4．21％。结论泪道探通术联合应用氧氟沙星眼膏留置泪道是治疗泪道阻塞的有效方法。     

婴幼儿泪道阻塞的治疗

目的探讨婴幼儿泪道阻塞的治疗方法：方法2个月内患儿采用泪囊区按摩法，大于2个月龄患儿采用泪道加压冲洗法，冲洗日超过15天仍不通者采用泪道探通术。结果5例经泪囊区按摩通畅；用泪道加压冲洗法治疗通畅119例129眼，占64％；用泪道探通法通畅63例67眼，占34％。结论泪道加压冲洗、泪道探通术效果好。     

泪道探通联合眼膏灌注治疗先天性鼻泪管阻塞

目的评价对患先天性鼻泪管阻塞的1岁内婴儿施行泪道探通术联合泪道内灌注氧氟沙星眼膏的临床效果。方法因持续性泪溢、泪道冲洗不通,经泪囊区局部按摩无效而被确诊为先天性鼻泪管阻塞的1岁内婴儿60例(67眼),在局麻下施行泪道探通术,并注入泪道以甲基纤维素为赋形剂的氧氟沙星眼膏,术后点滴氧氟沙星眼水1wk。分别于术后3,7d进行泪道冲洗,随访3mo,观察其临床症状的改善情况。结果所有60例(67眼,100%)通过1～3次的治疗均获临床治愈。其中,1次治愈64眼,治愈率95.5%(64/67);2例(2眼)在首次术后3d因冲洗泪道不通而再次手术后获治愈(3%,2/67);1例1眼)则连续进行了3次手术方获治愈(1.5%,1/67)。无1例造成假道,唯一常见的并发症是在9例(10眼,14.9%)术后鼻腔分泌物中见少许血染。结论对不满1岁的婴儿在局麻下施行鼻泪管探通术联合氧氟沙星眼膏灌注治疗其先天性鼻泪管阻塞是十分安全、简捷而有效的方法。     

先天性泪道阻塞探通治疗的临床体会

目的：观察1~6月龄先天性泪道阻塞并泪囊炎的婴幼儿泪道探通治疗效果及泪道继发性粘连发生情况,按年龄分为1~3月龄组和3~6月龄组,对疗效及粘连发生率进行比较总结,确定最佳探通治疗时机。 方法：随机选取2007-06/2011-12期间来我院就诊的1~6月龄先天性泪道阻塞并泪囊炎患儿288例,其中男150例,女138例,单侧230例,双侧58例,年龄30~180（平均86.66±40.55）天龄。将患儿按照年龄段分为2组：第1组（观察组）1~3月龄,173例;第2组（对照组）3~6月龄,115例。两组治疗方法相同,用10g/L丁卡因表面麻醉泪小点,适当扩张下泪小点,用外径0.5mm或0.6mm带侧孔的圆头冲洗式探针常规操作冲洗探通泪道,但是探针进入泪囊后与水平线夹角应保持75°~85°,探通泪道成功后,将探针留置在泪道30~60min扩张泪道。拔除探针时患儿采取俯卧位,尽量冲净泪道残留分泌物及细胞碎屑。探通过程中记录泪道粘连情况,术后4~6d复诊冲洗泪道,观察、巩固疗效。随诊3~6mo,对两组疗效及泪道出现继发性粘连情况进行比较。 结果：第1组治愈率98.1%,泪道继发性粘连率29.3%。第2组治愈率82.6%,泪道继发性粘连率高达70.3%。通过统计学分析,两组疗效具有显著性差异,1~3月龄组疗效明显好于3~6月龄组;前者泪道继发性粘连发生率也明显低于后者。 结论：对于先天性泪道阻塞并泪囊炎的患儿提前到1~3mo内进行探通治疗效果很好,病情时间越长,泪道继发性粘连的机会愈多,疗效降低。以往多主张6月龄后再行泪道探通,通过临床观察,我们认为在1~3月龄内为最佳探通时间,适合在基层医院广泛推广应用。     

Evaluation of therapy outcome in congenital nasolacrimal duct obstruction in own material

The inborn nasolacrimal duct obstruction is common ocular disease in new-borns and infants. There are still doubts concerning the timing of the operating procedure. Probing of the lacrimal ducts is the therapeutic method for this condition. PURPOSE: To evaluate the therapy outcome in congenital nasolacrimal duct obstruction in authors' own material. MATERIAL AND METHODS: In retrospective study of 3950 medical records of children from our Outpatient's Clinic, we distinguished 192 children with nasolacrimal duct obstruction. Then, we evaluated the outcome of implemented treatment in correlation with their age and timing of the nasolacrimal duct probing. RESULTS: All children with nasolacrimal duct obstruction had mucopurulent discharge in the lacrimal sac and lacrimation. After the conventional treatment, the disease resolved in 23% of our group, whereas, in the rest of the patients probing of the nasolacrimal duct was implemented. The probing was successful in all children, but it was necessary to repeat the procedure twice in 13 children and three times in 5 children. The success rate of single probing was as follows: 91% in the group of children 1 - 3 months old, 83% in both groups: 3 - 6 and 6 - 12 months old and 71% in the oldest group of children - above 1 year of age. CONCLUSIONS: In majority of children the nasolacrimal duct obstruction did not resolve spontaneously. Early probing within first few months of child's life increased the success rate of this procedure.     

鼻泪管膿液抽吸术治疗新生兒泪囊炎

目的 探讨鼻泪管膿液抽吸術治療新生兒泪囊炎。方法 新生兒泪囊炎用按摩、冲洗泪道、探通泪道治療方法無效者,用6號空心泪道探针抽吸鼻泪管膿液,然后冲洗泪道。结果 36人39眼中32人35眼抽出约0.5-0.6ml不等量的粘稠膿液,再冲洗泪道通畅。使新生兒泪囊炎治愈率提高15.49％。结论 根據婴幼兒泪道解剖特黠和臨床实践,發现部分新生兒泪囊炎患兒泪囊和鼻泪管同时存在横膿,鼻泪管抽吸術作为泪道探通術失败后的一種補充治療方法,可以明顯提高新生兒泪囊炎的治愈率。     

鼻泪管支架置入治疗鼻泪管阻塞108例观察

目的 观察鼻泪管支架置入治疗鼻泪管阻塞的有效性和实用性.方法 对108例(108只眼)鼻泪管阻塞患者行鼻泪管支架置入术,按照随访时间分两组:A组术后随访3年以上,共57例;B组随访6个月到1年,共51例,使用卡方检验比较两组间的治愈率.结果 A组治愈率80.7%,B组治愈率82.3%,两组间差异无统计学意义.结论 鼻泪管支架置入治疗鼻泪管阻塞安全有效.

Abstract：

Objective To observe the efficacy and practicability of the treatment for nasolacrimal duct obstruction with nasolacrimal stent implantation.Methods One hundred and eight cases(108 eyes)of nasolacrimal duct obstruction were placed nasolacrimal stent.All patients were divided into two groups according to postoperative follow-up time.Group A consisted of 57 cases and were observed for more than 3 years after operation.Group B consisted of 51 cases and were observed 6 months to 3 years.A chi-square test was used to compare these two groups.Results The cure rates of Group A and Group B were 80.7% and 82.3% respectively.There was no significant difference in cure rate between these two groups.Conclusions The treatment for nasolacrimal duct obstruction with nasolacrimal stent implantation is convenient method with higher successful rate,minimal tissue damage and simple appliance.     

Long-term results of closed nasolacrimal intubation in adults

PURPOSE: Dacryocystorhinostomy (DCR) is the standard surgical treatment for adult nasolacrimal duct obstruction. There have been relatively few studies of closed nasolacrimal duct intubation in adults. The aim of this study was to determine rates of anatomic patency following this procedure. METHODS: The authors carried out a survey of all patients undergoing closed nasolacrimal duct intubation as a primary procedure over a period of 3 years and 4 months. There were 32 eligible patients of whom 20 attended for review. RESULTS: A total of 75% of these cases had patent drainage after follow-up of between 6 months and 3 years. The proportion of patients with persistent patency after intubation was the same regardless of length of follow-up. CONCLUSIONS: The minimally invasive procedure of lacrimal intubation may have a role in some adults with nasolacrimal duct obstruction.     

人工鼻泪管植入术后并发症的分析研究

探讨人工鼻泪管植入术后并发症发生的原因,寻找有效的处理方法。 方法：对我院2009-05/2010-10行人工鼻泪管植入3mo以上的泪囊炎及鼻泪管阻塞患者146例160眼进行回顾性分析,总结分析手术后并发症发生原因,观察并发症处理的方法和效果。 结果：患者146例160眼中共37眼发生并发症,3眼（81%）因眉弓过高、泪囊-鼻泪管夹角太大;3眼（8.1%）因外伤性泪囊炎鼻泪管狭窄,扩张器不能进入鼻泪管而改行手术治疗;5眼（13.5%）在1mo后出现人工鼻泪管下滑移位行再次植入;20眼（54.1%）术后6mo发生肉芽组织增生和阻塞;6眼（16.2%）术后12mo发生肉芽组织增生和阻塞。经扩张后注入丝裂霉素C与妥布霉素地塞米松眼膏5眼恢复通畅,失败病例行泪囊鼻腔吻合术或经鼻泪囊开窗引流术。 结论：人工鼻泪管蘑菇头部位肉芽组织增生造成阻塞是人工鼻泪管植入最常见并发症,发生率与植入时间成正比,人工鼻泪管植入要严格掌握适应证,慢性泪囊炎的治疗应以手术治疗为首选方法。     

The polyurethane nasolacrimal duct stent for lower tear duct obstruction: long-term success rate and complications

Background: The polyurethane nasolacrimal duct stent is used as an alternative to conventional techniques for treatment of lower tear duct obstruction. The aim of this study was to evaluate the clinical success rate after a follow-up of 2 years. Methods: Nasolacrimal duct stent implantation was attempted in 19 patients with nasolacrimal duct obstruction proven by digital substraction dacryocystography. The median age of the patients was 50 years, and the minimum duration of symptoms was 3 months. Patients were followed up 1 week, 6 months, 1 year and 2 years after the procedure. Results: Eighteen stents were implanted in 17 patients without surgical complications. All stents were proven to be patent at the end of the procedure. Success rate, defined as proportion of patients free of symptoms, was 66.6%, 55.5% and 50% after 1 week, 6 months and 1 year, respectively, and remained unchanged thereafter. Three stents had to be removed between 6 months and 2 years after implantation. Histological examination showed granulation tissue growing into the opening and obstructing the stent in one case. Conclusion: Implantation of a polyurethane nasolacrimal duct stent is an alternative to conventional techniques in lower tear duct obstruction. Its overall success rate is lower than that reported after conventional dacryocystorhinostomy, but the procedure is fast, safe and reversible. Refinement of the surface and stent design may improve results in the future. Received: 8 February 2000 Revised: 12 April 2000 Accepted: 31 May 2000     

Treatment of nasolacrimal duct obstruction in adults with polyurethane stent

PURPOSE: To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal duct obstruction in adults. MATERIALS AND METHODS: In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 hollow polyurethane stents designed by Song and associates were placed under fluoroscopic guidance. The obstruction was complete in 20 lacrimal drainage systems and partial in eight. The lacrimal sac size was normal or large on dacryocystogram in all lacrimal drainage systems. A Ritleng probe was introduced through the upper punctum and advanced past the obstruction. A guide wire with a flexible tip was then introduced through the probe, over which the stent was advanced in retrograde fashion and placed into the lacrimal sac and nasolacrimal duct. Clinical success was defined by the demonstration of a completely patent lacrimal drainage pathway through saline irrigation and no or minimal complaint of epiphora. RESULTS: Stent placement was technically successful in 26 of 28 lacrimal drainage systems (93%). The mean time of fluoroscopy screening was 3.2 minutes (range, 1.4 to 5.8 minutes). The overall success rate was 82% (23 of 28 lacrimal drainage systems). Two stents were completely occluded. In one lacrimal drainage system with minimal epiphora, the stented drainage pathway was partially occluded. The patients were followed up from 4 to 22 months (mean, 7.2 months). CONCLUSIONS: Retrograde placement of a hollow polyurethane nasolacrimal duct stent is a technique that is simple and well tolerated by patients. This method achieves a high success rate and may be suggested as a nonsurgical procedure for adults with primary nasolacrimal duct obstruction and proper lacrimal sac size. The Ritleng probe facilitates the procedure.