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）     

Treatment of Acute Purulent Dacryocystitis by Early Bicanalicular Silicone Intubation: Safety,Efficacy, and Outcomes

Purpose: To evaluate the safety, efficacy, and outcomes of early bicanalicular silicone intubation in the treatment of acute purulent dacryocystitis. Methods: This prospective interventional case series focused on acute purulent dacryocystitis from February 2010 to March 2014. Of the 21 cases, 16 cases were treated at the Fujian Provincial Hospital, and five cases were treated at the Lianjiang Hospital. Bicanalicular silicone intubation was inserted in the original lacrimal duct within 10 days after abscess decompression by pus aspiration method and systemic antibiotic application. Data collection included demographic profiles, perioperative and postoperative complications, and revision surgery. Resolution of signs and symptoms of acute purulent dacryocystitis, as well as successful anatomical patency assessed by irrigation, was evaluated. Follow-up times were more than 12 months, and ranged from 14 to 63 months.

Results: All patients showed remarkable improvement of pain and swelling within 48 hours. Resolution of the erythema and edema was observed within one week after bicanalicular silicone intubation combined with topical antibiotic lavage. No intraoperative and postoperative complications were observed. After initial bicanalicular silicone intubation, anatomical success was observed in 66.7% (14/21) of the patients. Of the remaining seven patients who presented with severe reflux in irrigation, two patients chose re-intubation and five patients underwent standard external dacryocystorhinostomy. All patients had anatomical success at last follow-up. Conclusion: Early bicanalicular silicone intubation appears to be a safe, effective, and simple procedure, which offers a reasonable option in the treatment of acute purulent dacryocystitis, especially for those developing and underdeveloped areas.     

鼻泪管逆行植入球头硅胶管术治疗慢性泪囊炎的临床分析

目的:观察、分析鼻泪管逆行植入球头硅胶管术治疗慢性泪囊炎的临床疗效及基层医院推广价值。方法:采用鼻泪管逆行植入球头硅胶管术治疗慢性泪囊炎35例37眼。结果:对35例37眼术后1a内进行随访,其中34眼治愈,溢泪解除,分泌物消失,3眼无效,治愈率92%。结论:鼻泪管逆行植入球头硅胶管术治疗慢性泪囊炎疗效确切,简单易行,费用低,基层医院值得推广。     

鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的临床效果

目的：探讨术前解读泪道造影和眼眶CT的重要性以及鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的治疗效果。方法：回顾性研究。统计分析2016年4月至2019年3月在吉林大学第二临床医院行鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的患者资料13例（14眼）,包括病史、术前泪道造影、眼眶 CT片和术中情况。术后观察患者症状改善与否,泪道冲洗结果及鼻内镜下观察造口的情况,随访6个月评估手术疗效。结果：通过CT阅片发现3眼泪囊移位（其中1眼合并泪骨骨折）,6眼同时合并上颌骨额突和鼻骨骨折（其中1眼见瘢痕组织增生于骨折片间）,5眼仅见鼻泪管骨折,泪囊位置及局部解剖未见明显异常。14眼均成功行鼻内镜下泪囊鼻腔造口术,其中1眼因泪囊移位明显联合植入泪囊鼻腔引流支架。12例（13眼）治愈,1例（1眼）未愈。术中易出血,术后无并发症,随访6个月均无复发。结论：鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎安全有效,并发症少。术前阅读泪道造影 CT片有助于术中泪囊的准确定位和完全暴露,提高手术效率。     

改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C治疗慢性泪囊炎

目的:探讨慢性泪囊炎手术治疗的有效方法。方法:收集30例慢性泪囊炎患者,行改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C应用慢性泪囊炎疗效观察。结果:术后随访6～24mo,治愈29例,治愈率97%,无效1例。结论:改良鼻内窥镜下泪囊鼻腔吻合联合置管术和丝裂霉素C应用治疗慢性泪囊炎具有治愈率高,面部无瘢痕,出血少,进路直接,泪囊定位准确,同时丝裂霉素棉片留置,有抑制创面肉芽组织生长和纤维瘢痕形成,提高手术成功率。     

High Prevalence of Biofilm-Forming MRSA in the Conjunctival Flora in Chronic Dacryocystitis

Objectives: To report the microbiological spectrum of conjunctival flora and prevalence of biofilm-forming Methicillin-resistant Staphylococcus aureus (MRSA) in conjunctival flora in chronic dacryocystitis.

Design: Prospective, case-control study.

Methods: We included patients with unilateral chronic dacryocystitis, and their unaffected eyes as control. Microbiological profile and antibiotic susceptibility of the isolates was determined by standard microbiological procedures. S. aureus isolates were further evaluated for Methicillin resistance by Oxacillin resistance screening agar method and mecA polymerase chain reaction (PCR) and for biofilm synthesis by Congo red agar method, Microtitre plate (MTP) assay, and ica A and ica D PCR.

Results: We found 95 patients with unilateral chronic dacryocystitis. Aerobic Gram-positive isolates (74.2%, n = 72) were more than Gram-negative (25.7%, n = 25) or anaerobic isolates (20.5%, n = 25). S. aureus was most common (46.4%, n = 45), followed by Pseudomonas aeruginosa (10.3%, n = 10). Gram-positive isolates showed highest sensitivity to Linezolid (100%) and higher generation fluoroquinolones. Gram-negative isolates showed good sensitivity (>90%) to all tested antibiotics. S. aureus isolates showed MRSA prevalence as 93.5% and 96.9% by Oxacillin resistance screening agar method and mecA PCR, respectively. Biofilm formation was found in 71.8% MRSA isolates by MTP assay and 58.1% MRSA isolates were resistant to ≥3 classes of antibiotics.

Conclusions: Gram-positive organisms, specifically S. aureus, are the major etiological agent in chronic dacryocystitis. There is high prevalence of MRSA in these isolates and concurrent biofilm formation.     

两种联合手术治疗慢性泪囊炎合并上泪道阻塞的疗效比较

目的:观察两种联合手术治疗慢性泪囊炎合并上泪道阻塞的疗效.方法:慢性泪囊炎合并上泪道阻塞患者68例68眼,采用随机数字表法分为A组和B组,每组34例.A组采用鼻内镜下泪囊鼻腔吻合联合硅胶管置入术.B组采用传统泪囊鼻腔吻合联合硅胶管置入术,所有患者均随访1a.结果:A组患者治疗总有效率为82%,B组为79%,两组比较差异无统计学意义(P>0.05).A组术后面部肿胀发生率为6%、面部瘢痕发生率为0,B组分别为47%、100%,A组并发症的发生率明显低于B组,两组比较差异均有统计学意义(P<0.05).A组患者满意度为82%,B组为59%,A组明显优于B组,两组比较差异有统计学意义(P<0.05).结论:鼻内镜下泪囊鼻腔吻合联合硅胶管置入术安全性高,损伤小,且术后并发症少,患者满意度高,是治疗慢性泪囊炎合并上泪道阻塞比较理想的手术方法.     

内窥镜下改良球形头硅胶管插管与泪囊鼻腔吻合术治疗鼻泪管阻塞的比较

目的:比较内窥镜下球形头硅胶管插管(SHSI)与泪囊鼻腔吻合术(En-DCR)治疗鼻泪管阻塞(NLDO)的疗效与经济效益。方法:将43例50眼NLDO患者随机分为SHSI组(21例25眼)和En-DCR组(22例25眼),比较两组患者术中出血量、单眼手术时间、手术不适及住院时间,随访至术后12mo,根据末次随访时溢泪与泪道灌洗情况评估临床疗效,并采用成本-效果比(C/E)进行经济效益评估。结果:SHSI组患者术中出血量与手术不适视觉模拟评分显著低于En-DCR组(4.96±1.989mL vs 27.60±14.950mL,2.84±0.64分vs 4.88±0.84分),单眼手术时间与住院时间显著短于En-DCR组(13.40±6.007min vs 59.64±12.786min,0.50±0.010h vs 137.280±23.085h)(均P<0.001)。末次随访时,两组患者临床有效率无差异(88%vs 96%,P>0.05),但SHSI组患者C/E(13.57)远小于En-DCR(121.50)。结论:内窥镜下SHSI与En-DCR均为NLDO的有效手术治疗方法,但SHSI手术难度相对更低且具有明显的成本效益优势。     

不同手术方法治疗鼻泪管阻塞继发泪囊炎的临床研究

目的：对比分析三种术式治疗鼻泪管阻塞继发泪囊炎的疗效以及安全性,探索临床治疗鼻泪管阻塞继发泪囊炎的最佳术式。方法：选取2010-01/2016-01我院收治的鼻泪管阻塞继发泪囊炎患者348例397眼作为研究对象,根据手术治疗方案不同分为3组：泪道激光组接受泪道激光成行术治疗130例152眼、鼻泪管组接受人工鼻内管支架植入术治疗113例127眼、鼻内镜组接受鼻内镜泪囊鼻腔吻合术治疗105例118眼,对比分析3组患者的治疗效果及不良反应发生率。结果：术后1mo,3组患眼治疗效果差异有统计学意义( P<0.05),泪道激光组治疗效果显著优于鼻泪管组、鼻内镜组(P<0.05),鼻泪管组与鼻内镜组治疗效果相比差异无统计学意义(P>0.05)。术后4mo,3组患眼治疗效果比较结果与术后1 mo完全一致,但是3组患者术后4 mo的治疗效果均显著变差,差异有统计学意义(P<0.05)。3组患者不良反应发生率差异有统计学意义(P<0.05),泪道激光组不良反应发生率显著低于鼻泪管组、鼻内镜组,差异有统计学意义(P<0.05),鼻泪管组与鼻内镜组不良反应发生率相比差异无统计学意义(P>0.05)。3组患眼复发
　　率比较差异无统计学意义(P>0.05)。结论：泪道激光成行术治疗鼻泪管阻塞继发泪囊炎的疗效与安全性均良好。