环形置管术治疗外伤性上下泪小管同时断裂的疗效观察

目的 观察外伤性上下泪小管同时断裂行环形置管吻合术的手术方法和疗效.方法 对18例（18只眼）外伤性上下泪小管同时断裂的患者在手术显微镜下寻找断端进行环形置管吻合术.结果 18例（18只眼）成功实施环形置管吻合术,术后3个月拔除留置的硅胶管,15例泪道冲洗通畅无泪溢,占83.33％;3例冲洗通而不畅,无明显或轻度泪溢,占16.67％.结论 对外伤性上下泪小管同时断裂的患者行环形置管吻合术,同时恢复了上下泪小管的解剖结构和生理功能,效果良好,方法操作方便,值得临床推广.     

泪小管断裂显微吻合术

目的总结泪小管外伤性断裂显微吻合术的疗效。方法对68例（68眼）泪小管断裂采用多种方法寻找断端，留置硬膜外麻醉管为支撑物，进行断端吻合。结果拔除置管后行泪道冲洗，所有的病例均泪道通畅，无溢泪现象。随访3月～6年，平均2．6年。泪道冲洗通畅64眼，成功率94．12％。结论该手术方法创伤小，并发症轻，术后外观及功能良好。     

泪小管断裂显微吻合术

目的:评价外伤性泪小管断裂显微吻合手术的效果。方法:显微镜直视下寻找鼻侧泪小管断端,以硬膜外麻醉导管为支撑的吻合方法治疗泪小管断裂87例,置管2～3mo。拔管后随访3～24mo。结果:82例随访,68例泪道冲洗通畅,无泪溢;8例冲洗泪道通畅,有泪溢;6例通而不畅。结论:以硬膜外导管为支撑,显微镜直视下寻找泪小管鼻侧断端,治疗外伤性泪小管断裂效果满意。     

新型隐匿性泪道支撑管治疗儿童泪小管断裂

目的评价新型隐匿性泪道支撑管置入治疗儿童外伤性泪小管断裂的效果。方法采用全身麻醉,以新型隐匿性泪道支撑管为载体手术显微镜下吻合新鲜儿童外伤性泪小管断裂40例（40眼）,术后保留支撑管3个月,拔管后再随访3个月。结果术中40例全部成功吻合。留置的支撑管无意外脱落现象。术后3个月拔管时,35例（87．5％）治愈;4例（10．0％）好转,轻度溢泪,泪道不畅;1例（2．5％）未愈,下睑外翻,溢泪泪道不通。拔管3个月后,38例排泪正常,治愈率为95％;其中1例（2．5％）好转,轻度溢泪,泪道不畅;1例（2．5％）未愈,皮肤瘢痕和下睑外翻,明显溢泪症状,泪道不通。结论利用新型隐匿性泪道支撑管治疗儿童外伤性泪小管断裂是一个可行的治疗方式。     

静脉留置针软管在外伤性泪小管断裂吻合术中的应用

目的 探讨静脉留置针软管在外伤性泪小管断裂吻合术中应用的临床效果.方法 16例(16眼)患者外伤性下泪小管断裂吻合术中用静脉留置针软管作为支撑物,置管保留3个月后拔出,拔管后随访6～12个月.结果 15例(93.75%)患者无溢泪,泪道冲洗通畅,下泪小点无损伤.1例(6.25%)患者于术后2周,误将置管拔出仍有溢泪.结论 外伤性下泪小管断裂吻合术中用静脉留置针软管作为支撑物疗效满意.     

泪小管修复术

目的探讨外伤性泪小管断裂的修复术的效果。方法收治外伤性泪小管断裂共58例（58眼），在手术显微镜下寻找到泪小管断端后置管，然后断端用10—0缝线对接缝合3—4针，1-3月后拔管，随访观察泪道通畅情况。结果58例都能在手术显微镜下成功找到泪小管的两断端。痊愈37例（63．79％），好转19例（32．76％），无效2例（3．45％）。结论置入直径0．8mm硬膜外麻醉聚乙烯管支撑物，此管弹性好，有刻度，无刺激性，可较长时间留置。     

儿童泪小管断裂显微吻合术效果分析

目的探讨儿童外伤性下泪小管断裂吻合术的手术方法及其疗效。方法回顾性分析28例（28眼）儿童外伤性泪小管断裂,在手术显微镜下采用泪小管断裂吻合术,2～3个月后拔管,观察眼睑及泪点位置及泪道通畅情况。结果术后下泪点位置正常,眼睑皮肤愈合良好,无眼睑畸形,术后测泪膜破裂时间及Schirmer实验正常,拔管前和拔管后行泪道冲洗均通畅,手术成功率达96.43%。随访12～24月,痊愈20例（71.43%）,好转7例（25.00%）,无效1例（3.57%）。结论泪小管显微吻合术是治疗外伤性下泪小管断裂的有效手术方式,采用儿童输尿导管支撑断裂泪小管行吻合术操作简单,疗效良好。     

硅胶泪导管双头双路插管法在外伤性泪小管断裂吻合术中的应用

目的探讨硅胶泪导管为内置管的双头双路插管在治疗外伤性下泪小管断裂的手术方法及术后效果。方法 23例（23眼）在手术显微镜直视下寻找下泪小管鼻侧断端,并以双头硅胶泪导管为支撑物插管,插管的另一端从上泪小管插入,两端从下鼻道内拉出后留适当长度置于下鼻道内。结果 23例术后泪道冲洗均通畅,患者对外观均满意,都能完成治疗周期顺利拔管。结论双头双路泪道插管法在外伤性泪小管断裂吻合术中因其手术方法简单,外固定牢效果好,不影响患者外观。     

逆行注水法及丝裂霉素C修复泪小管断裂

目的探讨泪小管断裂修复术中，逆行插管注水法寻找鼻侧断端的可行性以及丝裂霉素C（MMC）预防吻合口纤维化的临床疗效。方法对46例（46眼）外伤性泪小管断裂，在鼻内窥镜下从鼻泪管下端开口逆行插管注水，寻找鼻侧断端，并于术中及术后应用MMC。结果46眼均顺利找到鼻侧断端，成功吻合。随访6-36月：泪溢症状消失，冲洗泪道通畅35眼；泪溢症状减轻，冲冼泪道通畅7眼。有效率为91．30％；泪溢症状无改善，冲洗泪道不通4眼，无效占8．70％。结论对外伤性泪小管断裂，尤其是上、下泪小管同时断裂或泪总管断裂，采用逆行插管注水是寻找鼻侧断端的可靠方法。MMC可抑制吻合口的纤维化，提高疗效。     

双路泪道插管法行外伤性泪小管断裂吻合术

目的 探讨双路泪道插管法并置管固定治疗泪小管断裂的手术方法及术后效果.方法 23例(23眼)外伤性泪小管断裂,在手术显微镜直视下寻找、吻合断端,以硬膜外导管为支撑物,另一端自上泪小管插入,两端于鼻腔拉出后固定藏于鼻腔内.结果 23例术后泪管冲洗均通畅,1例有轻度溢泪,1例患者诉眼部轻度异物感,所有患者无外观不满意抱怨,均能顺利配合治疗至拔管.结论 双路泪道插管法行外伤性泪小管断裂吻合术,其固定效果牢固,外观较满意,易于被患者接受.     

双路泪道硅胶引线管在外伤性下泪小管断裂的临床应用

目的：探讨双路泪道留置引线硅胶管治疗外伤性下泪小管断裂的应用及效果。 方法：回顾性病例研究。2008-10/2011-09我院收治32例32眼外伤性下泪小管断裂患者,采用双路泪道留置硅胶管,主要评价拔管6mo后泪道冲洗通畅情况。 结果：拔管6mo后治疗有效率为29例（91%）,而治疗无效3例(9%)。 结论：采用双路泪道留置硅胶管植入术治疗外伤性下泪小管断裂,术后外观及疗效满意,易于被患者接受,值得临床推广。     

泪道探通联合硅胶支撑管环形置入的临床应用

目的观察泪道探通联合泪道内硅胶支撑管环形置入在鼻泪管阻塞及泪小管断裂中的临床效果。方法对鼻泪管阻塞48例（53眼）及泪小管断裂24例（24眼）,共72例（77眼）,施行泪道探通联合泪道内硅胶支撑管环形置管治疗。结果术后随访6月～1年,治愈58眼,好转15眼,无效4眼。结论泪道探通联合泪道内硅胶支撑管环形置入是治疗鼻泪管阻塞及泪小管断裂的有效方法。     

眼烧伤双路环形硅胶管置入保护泪点临床观察

目的 观察双路环形硅胶管置入泪道在眼烧伤中对于泪点保护的临床效果。方法 眼烧伤并有眼睑烧伤住院者35例（41眼）。采用双路环形硅胶管置入对泪点进行保护。3月后拔管,随访6月。结果 除1例（1眼）因泪点糜烂提前拔管致泪点狭窄（2．44％）外,余34例（40眼）（97．56％）泪点位置及形态均正常,无泪点闭锁情况,泪道冲洗均通畅。结论 双路环形硅胶管置入在眼烧伤中对泪点起到有效的保护作用,操作简便、创伤小、疗效好。     

双泪道硅胶插管泪小管吻合术的临床应用

目的探讨双泪道硅胶插管在泪小管断裂吻合术中运用治疗效果及舒适度。方法泪小管断裂40例（40眼），分为两组。10例以硬膜外麻醉管为支撑物的方法行泪小管断裂吻合术；30例以双硅胶管为支撑物的方法行泪小管断裂吻合术。两种方法泪道置管都保留3个月后拔管，拔管后随访3～9个月，并对患者疗效及舒适度进行调查。结果双泪道硅胶插管做为泪小管支撑物，好转治愈率及舒适度良好以上都达96．67％。结论泪小管断裂吻合术中运用双泪道硅胶插管疗效良好，尤其是术后舒适度明显优于硬膜外麻醉管者。     

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.     

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。     

Use of silicone tubes to repair canalicular lacerations via a novel method

OBJECTIVE:To develop a novel method to repair canalicular lacerations using silicone tubes.;METHODS:A total of 47 adult patients (47 eyes) with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012. The age ranged from 16 to 53 years. Among the 47 eyes, 37 had lower canalicular lacerations, 6 had upper canalicular lacerations, and 4 had bicanalicular lacerations. A soft probe was made using a stainless steel acupuncture needle, which was inserted into the lumen of the proximal part of the catheter to increase its rigidity. The probe was then inserted into the lacrimal sac and nasolacrimal duct. After retrieval of the catheters, the two ends of the silicone tube were securely tied (end to end) to the catheters. The silicon tube outside the nostril formed a U-shape. The catheters were then pulled upward until the silicone tube was completely located in the canalicular system. The catheters were cut off of the silicone tube near the site of the connection. The two ends of the silicone tube were cut short, -2mm out of the lacrimal punctum, and tied securely, end to end. The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus, and the suture was removed through the nostril. The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).;RESULTS:All cases were anatomically rehabilitated after surgery. The silicone tube was removed after implanted in 3-10 months (mean 4.5 +/- 1.3 months), the average follow-up time was 11.8 months after removal. In total, 45 eyes in all 47 eyes (95.74%) were free from obstruction. Among them, 41 eyes (91.11%) achieved complete success (completely disappearance of epiphora after tube removal), 4 eyes (8.89%) achieved partial success (irritation occurs under stimulation conditions, such as wind or cold conditions), 4 eyes showed postoperative tearing, with three eyes having inferior lacrimal duct laceration, and one eye with superior canalicular laceration. Apart from two cases (4.26%) suffering inferior punctum splitting, no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.;CONCLUSIONS:For adult patients with canalicular laceration, the NCI was an effective, atraumatic surgery, which has fewer complications than traditional canalicular suture.     

逆行置管术治疗鼻泪管阻塞的临床研究

目的探讨泪道逆行置管术治疗成人鼻泪管阻塞的疗效及骨性鼻泪管解剖因素对疗效的影响。方法71例（75眼）成人原发性鼻泪管阻塞,术前行CT三维成像测量骨性鼻泪管的长度及最小直径,然后分别经鼻泪管逆行植入“Y”形泪道引流硅胶管,术后3～6个月拔出,随访1年以上。结果75眼均一次置管成功。拔管时泪道冲洗通畅67眼（89．33％）,冲洗有阻力8眼（10．67％）。拔管后1—3个月内有14眼再次阻塞（18．67％）。术前泪道CT三维成像测量结果统计学分析显示,治愈组与未愈组骨性鼻泪管平均长度：分别为（13．40±0．51）mm和（13．71±0．41）mm,骨性鼻泪管最小直径：分别为（3．47±0．34）mm和（3．23±0．28）mm差异均有统计学意义（t=4．81,t=5．64,P〈0．01）。结论泪道逆行置管术是治疗成人鼻泪道阻塞的较好方法。术前CT三维重建了解患者骨性泪道解剖特点,制定个性化治疗方案,可以提高泪道逆行置管术治愈率。