双泪小管置管法修复泪小管断裂的临床应用

目的 探讨应用硬膜外导管行双泪小管置管法修复泪小管断裂手术的安全性和有效性.方法 回顾性分析42例(42眼)采用硬膜外导管行双泪小管置管法修复泪小管断裂的病例资料,下泪小管断裂38例,上下泪小管断裂4例.手术均在手术显微镜下进行,用硬膜外导管(直径0.6 ～0.8 mm)作为泪管支架,从下泪点穿入从颞侧断裂口穿出,再从鼻侧断裂口穿入,经泪总管至鼻泪管.用8-0丝线吻合泪小管两断端2针,结节缝合结膜,肌层和皮肤.将硬膜外导管外露端反插入上泪点至泪囊.结果 42例中,治愈36例,基本治愈4例,无效2例.拨除硬膜外导管后,42例随访2～6个月.所有病例术后眼睑伤口愈合良好,泪点位置正且无裂伤,无眼睑或内眦外伤性畸形.结论 双泪小管置管法修复泪小管断裂,对泪道损伤小且支撑管隐蔽不影响患者外观,同时还克服了冬季导管外露的弊端.在上下泪小管断裂伤病例,可用一根支撑管吻合上下泪小管.     

"经皮肤一针吻合法"修复泪小管断裂的临床研究

目的:探讨经皮肤"一针吻合法"修复泪小管断裂手术的安全性和有效性。方法:回顾性分析32例(32眼)采用"经皮肤一针吻合法"修复的泪小管断裂病例资料,下泪小管断裂29例,上泪小管断裂1例,上下泪小管同时断裂2例。手术均在手术显微镜下进行,用5-0丝线缝合,用直径为0.8mm硅胶管作为泪管支架插入吻合的泪小管,术后3mo拔除泪管支架,随访时间3～36mo。结果:32例病例中,治愈28例(88%),基本治愈3例(9%),无效1例(3%)。拔除支架管后,29例患者随访1～36(平均12)mo,3例患者失随访。所有病例眼睑伤口愈合良好,无眼睑和内眦外伤性畸形。结论:"经皮肤一针吻合法"法修复泪小管断裂,能直接吻合泪小管的两断端,伤口不长期存留缝线,避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。这种方法简化了手术操作,减少了手术损伤,是经济、安全、有效的。     

"经皮肤一针吻合法"修复泪小管断裂的临床研究

目的探讨"经皮肤一针吻合法"修复泪小管断裂手术的安全性和有效性。方法回顾性分析32例(32眼)采用"经皮肤一针吻合法"修复的泪小管断裂。下泪小管断裂29例,上泪小管断裂1例,上下泪小管同时断裂2例。手术均在手术显微镜下进行,用5-0丝线缝合,用硬膜外麻醉导管(直径0.8mm)作为泪管支架,术后3个月拔除硬膜外麻醉导管支架。结果32例中,治愈28例(87.50%),基本治愈3例(9.38%),无效1例(3.12%)。拔除支架管后,29例随访1~36个月(平均12个月),3例失随访。所有病例眼睑伤口愈合良好。无眼睑和内眦外伤性畸形。结论"经皮肤一针吻合法"修复泪小管断裂,能直接吻合泪小管的两断段,伤口不长期存留缝线,避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。     

双泪小管置入硅胶管支撑泪小管断裂吻合口临床观察

我院自2006年2月引进广州市视博医疗保健研究所关于泪囊炎、泪小管阻塞5min术式手术治疗泪囊炎、泪道阻塞患者技术，在该技术的启发下，我们采用广州市视博医疗保健研究所研制的线形硅胶管（该导管外径0．65mm，经环氧乙烷灭菌，植入前不需任何特殊处理），对8例泪小管断裂患者采用双泪小管置入硅胶管支撑泪小管断裂吻合术，均经清创吻合一期治愈，现报告如下。     

环形置管法治疗泪小管断裂的探讨

下睑内侧裂伤 ,常伴有泪小管断裂 ,手术对位缝合困难且效果不尽人意。作者自 1995年起采用环形置管法治疗此症 ,获得满意效果 ,报告如下 :一般资料本组共 5 0例 ,男 45例 ,女 5例。年龄最大 69岁 ,最小 2岁。受伤到就诊时间最短半小时 ,最长 3天。车祸伤 18例 ,碰撞伤 2 6例 ,拳击伤 3例 ,狗咬伤 2例 ,鸡啄伤 1例。手术方法局部麻醉后 ,在断裂的睑组织中寻找泪小管远侧断端管口。然后用硬膜外麻醉导管自下泪点插入 ,从泪管断端穿出 ,再自泪小管远侧断端插入 ,直经泪囊鼻泪管出鼻腔。按上法用导管另一端 ,扩张泪点后将此管自上泪点插入直止鼻…     

下泪小管断裂41例手术分析

目的分析泪小管断裂吻合手术的手术技巧。方法回顾性分析41例下泪小管断裂吻合手术的3个关键步骤：寻找鼻侧断端、选择硅胶泪道支撑物、采用“经皮肤一针吻合法”吻合两断端。结果术后随访3个月至1年,痊愈38例占92．7％,有效3例占7．3％,无效0例。结论找到断端,合适的支撑物,精确地吻合是泪小管断裂修复成功的关键。     

外伤性泪小管断裂经上下泪小管置管吻合术

外伤性下睑撕裂伤常伴下泪小管断裂,这是临床上常见的眼外伤。将断裂的泪小管进行吻合,可以解除伤后的溢泪症状。泪小管断裂吻合术成功的关键是要找到泪小管近泪囊的断端(鼻侧断端),吻合下泪小管并在其中置管支撑,保证管腔再通。临床上寻找泪小管鼻侧断端的方法很多,如从上泪点注入消毒牛奶、维丁胶性钙或亚甲蓝等方法,支撑管通常是从下泪小管经断端、泪囊、鼻泪管进行。或在手术显微镜下直视寻找泪小管的断端。但这些方法在实践操作中都各有利弊。我院从1995～1999年自行设计经上、下泪小管置管行外伤性下泪小管断裂吻合术21例(21眼),取得较满意的效果,现介绍如下:     

经皮肤一针吻合法及引线型硅胶管在泪小管吻合术中的应用

目的:探讨"经皮肤一针吻合法"及硅胶管在修复泪小管断裂手术中的安全性和有效性。方法:回顾性分析26例(26眼)采用"经皮肤一针吻合法"及硅胶管修复的泪小管断裂病例资料,下泪小管断裂24例,上下泪小管同时断裂2例。手术均在显微镜下进行,6-0丝线缝合,直径0.65mm的硅胶管作为泪道支架插入吻合的泪小管。术后3～6mo拔除泪小管支架,随访12mo。结果:26例病例中治愈16例(治愈率62%),基本治愈6例(23%),无效4例(15%)。拔除支架后,21例患者随访1～12(平均6)mo。所有病例眼睑伤口愈合良好,无眼睑和内眦外伤性畸形。结论:经皮肤一针吻合法及硅胶管联合应用于泪道断裂修复是一种经济、安全、有效的手术方法。     

双泪小管鼻泪管插硅胶管联合泪小管断裂吻合术的疗效观察

目的 观察双泪小管-鼻泪管插硅胶管联合泪小管断裂吻合术的疗效,寻求治疗泪小管断裂更合理的方法.方法 收集26例(26眼)外伤性泪小管断裂患者,其中下泪小管断裂22例,上下泪小管同时断裂4例,所有患者采用双泪小管-鼻泪管插硅胶管术,以硅胶管作支撑,进行泪小管断端显微吻合.术后常规抗炎治疗,术后7 d拆线,2个月时拔管.结果 26例患者中,有2例术后出现吻合口哆开,再次吻合后创面愈合良好.术后2个月拔管时,无溢泪、泪小点裂伤、眼睑畸形、硅胶管脱落发生.随访5～18个月,全部患者泪小点复位良好,泪道冲洗通畅,23例患者无溢泪,治愈率为88.5%;3例患者有溢泪,好转率为11.5%.结论 双泪小管-鼻泪管插硅胶管联合泪小管断裂吻合术,手术成功率高,并发症少,是治疗外伤性泪小管断裂的理想方法.     

改良双路硅胶支撑管置管术治疗泪小管断裂

目的 评价改良双路硅胶支撑管置管法治疗泪小管断裂的临床疗效.方法 52例（52眼）泪小管断裂手术,A组25例,采用传统腰麻导管做支撑管,单路插管后行泪小管吻合术;B组27例,采用双路硅胶支撑管置管术,并用改良手术方法吻合泪小管.术后随访3～18月,比较两种方法在手术时间、治愈率、泪点及泪小管撕裂等3个方面差异.结果 A组手术时间（71.80±36.22）min,完全治愈13例,无效4例,泪点及泪小管撕裂8例.B组手术时间（108.78 ±57.01） min,完全治愈23例,无效0例,泪点及泪小管撕裂2例.B组较A组手术时间有所延长,但其手术治愈率高于A组,泪点及泪小管撕裂率低于A组,差异均具有统计学意义.结论 改良双路硅胶支撑管置管治疗泪小管断裂方法简单、实用,疗效好,并发症少.     

新型硅胶管治疗泪小管断裂的临床疗效

目的： 评价新型硅胶管(RS一次性使用泪道引流管)治疗泪小管断裂的临床效果。

方法： 回顾性研究。收集2013-01/2015-10来我院就诊的47例47眼泪小管断裂患者完整的临床资料。在泪小管断裂吻合术中,新型硅胶管从上、下泪小点 “U” 形置入,在泪道中保留3mo。拔管后,观察泪道通畅率、是否伴有泪溢和其他并发症发生情况。

结果： 所有患者,泪小管吻合成功,新型硅胶管顺利植入。未发生硅胶管相关的并发症,如眼部刺激、泪小点外翻和撕裂、过早脱落等。治愈41例(87%),泪道冲洗通畅,无泪溢。部分治愈4例(9%),患眼轻微泪溢,但泪道冲洗通畅。失败2例(4%),患眼泪溢,泪道冲洗不畅。

结论： 在泪小管断裂吻合术中,新型硅胶管是一种安全、有效、无创的置入物,其操作过程简单,易于掌握,术者学习曲线短。     

A newly designed silicone tube for the treatment of canalicular laceration

AIM: To evaluate the clinical efficacy of a newly designed silicone tube for the repair of canalicular lacerations. METHODS: This was a prospective clinical study. Data were analyzed from 47 eyes of 47 patients presenting with traumatic canalicular laceration in our hospital from January 2013 to October 2015. The newly designed silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3mo. Dates of the lacrimal duct patency, epiphora, and eyelid shape were recorded. RESULTS: Surgery was performed successfully in all cases. No complications associated with the silicone tubes occurred. In total, 41 patients (87.23%) achieved complete success, 4 patients (8.51%) achieved partial success, and 2 patients (4.26%) had surgical failure. CONCLUSION: The newly designed silicone tube is an effective and atraumatic tool for the management of canalicular lacerations. The operation process is simple, and is easy to grasp for the surgeon.     

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM: To evaluate the characteristics of pupillo-accommodative functions in patients with idiopathic tonic pupil according to the time of onset, gender, and age.METHODS:Totally, 15 males and 19 females were divided into 2 groups depending on the time of disease onset:group Ⅰ (onset <2 months, n=20) and group Ⅱ (onset >2 months, n=14). A supersensivity test was conducted by applying diluted pilocarpine 0.125% to the eye and accommodative functions were evaluated using the near-point of accommodation (NPA) as the cutoff point, at which the patient experienced blurred vision. Pupil size and the ratio of decrease in the affected pupilafter instillation of 0.125% pilocarpine were investigated.RESULTS:There was no significant difference between the 2 groups regarding the various pupillary reflex results, including data on the affected pupil size before and after 0.125% pilocarpine, anisocoria, and ratio of pupil decrease. No significant difference in NPA was found between the 2 groups. However, female patients were noted to have greater anisocoria and a faster constriction ratio than those of the male patients (P=0.02 and P=0.04). On subgroup analysis, female patients from group Ⅱ had larger affected-pupil sizes before 0.125% pilocarpine instillation and longer NPAs than those of the male patients.CONCLUSION: No relationship was found between time of onset and dysfunction of pupillo-accommodative functions. Pupillo-accommodative functions and age were not related, except for the NPA.     

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM: To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with bicanalicular silicone tube (diameter was 8mm) intubation, for one lacerated canaliculi one-stitch anastomosis through the skin. The stents were left in place for 3 months postoperatively and then removed. The follow-up period was 3 - 36 months (average 14 months).RESULTS:In 15 patients, 13 patients were cured entirely, 1 patient was meliorated, 1 patient with no effects. All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Complication was seen in one case, for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7^th day after operation, when he came at the 15^th day, the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound, and the inside silicone tube was exposed, a promptly repair with 10-0 nylon suture was done, the wound healed in a week. There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye, the cut ends can be anastomosed directly, and with excellent cosmetic results, it is acceptable for the patients. For there is no suture remained in the wound permanently, so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi. It is simple, economical, effective and safe.     

两种类型泪道引流管治疗儿童泪小管断裂的临床观察

目的:观察RS-1型泪道引流管与常规硅胶泪道引流管治疗儿童泪小管断裂的临床疗效。方法:回顾性分析2015-01/2018-06河北省眼科医院眼外伤科儿童泪小管断裂患者48例48眼,按治疗方法分成两组:A组(常规硅胶泪道引流管组)25例25眼,B组(RS-1型泪道引流管组)23例23眼;两组患者均在全身麻醉下行泪小管断裂吻合术,术后3mo拔管,比较两组患者手术时间、临床疗效及并发症。结果:A组手术时间为44.92±14.45min,B组为31.78±7.40min(t=4.02,P<0.01);A组:20眼治愈(80%),2眼好转(8%),3眼未愈(12%),治疗有效率为88%;B组:19眼治愈(82%),2眼好转(9%),2眼未愈(9%),治疗有效率为91%(χ2=0.14,P>0.05)。并发症情况:A组下泪点及眼睑轻度外翻1眼(4%),泪小管撕裂2眼(8%),泪道置管脱落2眼(8%),鼻黏膜损伤3眼(12%),并发症总发生率32%;B组:下泪点及眼睑轻度外翻1眼(4%),泪小管撕裂1眼(4%),并发症总发生率9%(χ2=3.94,P<0.05)。结论:RS-1型泪道引流管与常规硅胶泪道引流管在儿童泪小管断裂吻合术中应用效果均良好,但RS-1型泪道引流管操作更简便,手术时间更短,并发症更少,更容易拔管。     

小儿外伤性泪小管断裂T型硅胶支撑管置管术的疗效观察

目的:观察T型硅胶支撑管置管术治疗小儿外伤性泪小管断裂的效果。方法:回顾性病例研究。选取南京市第三医院2016年8月至2020年1月住院的小儿外伤性泪小管断裂者25例(25眼),采用"双套环"技术顺行置入T型支撑管。术后3～6个月拔管,拔管后随访1～3个月,观察疗效。结果:25例中,治愈21例(84.00%,21/25...