先天性鼻泪管阻塞伴泪小管阻塞的泪道探通术

目的探讨先天性鼻泪管阻塞合并泪小管阻塞的患儿泪道探通术的效果。方法此病患儿27例（29眼）作为研究组，单纯鼻泪管阻塞23例（30眼）作为对照组。两组均行常规的泪道探通术，应用荧光染料消失试验（FDDT）及泪道冲洗方法，观察治疗效果。结果研究组中合并下泪小管阻塞13例（14眼），合并上泪小管阻塞者14例（15眼），成功疏通鼻泪管阻塞26眼，治愈率89．7％；对照组30眼治愈27眼，（治愈率90．0％），两组之间比较差异无统计学意义，χ2=0．002，P=0．965。成功疏通泪小管者在29眼中仅有11眼，占37．9％。术后FDDT比较，伴有泪小管阻塞组FD—DT0级小于对照组，FDDT1-2级大于对照组,χ2=7．096，P=0．029。鼻泪管探通成功但泪小管探通失败，仅存单个正常泪小管的17眼，仅存的上或下泪小管一部分能够起到有效的引流泪液的功能（上泪小管阻塞FDDT0级4眼，FDDT1级6眼，FDDT2级1眼，下泪小管阻塞FDDT0级1眼，FDDT1级3眼，FDDT2级2眼）。结论先天性鼻泪管阻塞伴泪小管阻塞的患儿，只要存在一个正常泪小管，应用泪道探通术解除鼻泪管阻塞的前提下，患儿溢泪症状较术前均有明显改善，单纯鼻泪管阻塞患儿术后泪液引流作用要好于合并泪小管阻塞者，上或下泪小管均可能起到有效的引流泪液的功能。

Probing for congenital nasolacrimal duct obstruction combined with canalicular stenosis

Objective To evaluate the effect of probing in the treatment of congenital nasolacrimal duct obstruction combined with canalicular stenosis in children. Methods The probing, irrigating and fluo- rescein dye disappearance test（FDDT） were performed in 29 eyes of 27 cases with congenital nasolacrimal duct obstruction combined with canalicular stenosis （ study group ） and 30 eyes of 23 cases with simple naso- lacrimal duct obstruction （control group） ,FDDT experiment and irrigation were applicated to evaluate effect of probing of lacrimal passage for nasolacrimal duct and lacrimal canalicular obstruction. Results In the study group ,there were 13 cases（ 14 eyes） with inferior lacrimal duct and 14 cases（ 15 eyes）with superior the obstruction of lacrimal canaliculus ,The nasolacrimal duct obstruction was patent in 26 eyes （89.7%） from study group and 27 eyes（ 90.0% ） in control group, There were no statistical difference between the two groups.χ2 = 0. 002,P = 0. 965 （ 〉 0.05）, In the study group, the canalicular stenosis was cleared in 11 eyes（37.9% ） compared with the control group, FDDT in the study group was lower at level 0, higher at level 1 2 ,χ2 = 7. 096, P = 0. 029. The superior canaliculus was blocked in 11 eyes （4 eyes with FDDT level 0, 6 eyes with FDDT level 1,1 eye with FDDT level 2 ） , and the lower canaliculus was blocked in 11 eyes （ 1 eye with FDDT level 0, 3 eyes with FDDT level 1,2 eyes with FDDT level 2） in 17 cases with patent na- solacrimal duct and blocked canaliculus. Conclusion Probing can first be effectively used in therapeutic applications in congenital nasolacrimal duct obstruction with lacrimal canaliculus obstruction in children, if there is one normal lacrimal canalieulus. The therapeutic effect is better in patient with simple nasolacrimal duct obstruction than in that combined with canalicular stenosis, and the superior or lower canaliculus candrainage tear effectively.