高频电泪道成形并环形泪道引流管置入联合针药治疗上泪道阻塞性病变

目的：探讨高频电泪道成形并环形泪道引流管置入联合针药治疗上泪道阻塞性病变的临床疗效。

方法：将我科2013-07/2016-06就诊的上泪道阻塞性病变患者共86例102眼，其中男26例28眼，女60例74眼。采用高频电上泪道浚通成形并环形硅胶引流管置入，结合中医针灸加口服自制中药治疗30d，术后跟踪随访6mo，观察疗效及并发症。

结果：选取102眼共治愈86眼(84.3%)，好转12眼(11.8%)，无效4眼(3.9%)，总有效率为96.1%。术中并发症情况：(1)眶内出血：2眼术中出现眶内出血，考虑系筛前神经阻滞麻醉时可能损伤筛前血管所致，经按压后出血停止，停止手术，5d后顺利完成手术。(2)泪小管豁裂，共3眼，系手术操作不慎、患者配合不佳所致，虽手术顺利完成，但术后泪小管豁裂。(3)行置管困难3眼，均形成医源性假道，建议去上级医院在内窥镜指导下完成浚通置管术。术后并发症情况：(1)泪小点豁裂 3眼(2.9%)，因无泪溢，故未予以处理。(2)人工泪小管脱落、部分脱出5眼(4.9%)，从鼻腔拉出后鼻前庭固定，完全脱出4眼(3.9%)，1眼重新置管，3眼因置管已达3mo，无明显溢泪等症状，未予处理。(3)内眦部刺激症状11眼(10.8%)，因轻微，对症处理后无特殊情况。(4)泪小管肉芽组织增生2眼(2.0%)，1眼位于泪小点周围，剪除增生组织后妥布霉素地塞米松眼药水点眼后消失，1眼位于泪小管内，拔出环形管后点妥布霉素地塞米松滴眼液或复方硫酸新霉素滴眼液滴眼后未继续增生，但泪道冲洗不通，归为失败。

结论：高频电泪道成形并环形泪道引流管置入联合针药治疗上泪道阻塞性病变可以提高临床疗效。

Effect of high-frequency electric lacrimal duct plasty and annular lacrimal drainage tube implantation combined with acupuncture on upper lacrimal duct obstruction

AIM:To investigate the clinical effect of high-frequency electric lacrimal duct plasty and annular lacrimal drainage tube implantation combined with acupuncture on upper lacrimal duct obstruction.

METHODS: A total of 86 patients(102 eyes)with upper lacrimal duct obstruction who were treated in our department from July 2013 to June 2016 were 26 males(28 eyes)and 60 females(74 eyes). The treatment was high-frequency electric lacrimal duct plasty and annular lacrimal drainage tube implantation, combined with traditional Chinese medicine acupuncture plus oral medicine made by our department for 30d, followed up for 6mo after surgery to observe the effect.

RESULTS: A total of 86 eyes(84.3%)were cured in 102 eyes, 12 eyes(11.8%)were improved, 4 eyes(3.9%)were ineffective, and the total effective rate was 96.1%.

Intraoperative complications: 1)orbital hemorrhage in 2 eyes, maybe caused by vessel injury at the front of ethmoidal sinus, the blood was stopped after press, the operation went successfully after 5d; 2)lacrimal duct rupture in 3 eyes, all because of uncareful operation or weak compliance; 3)the duct was hard to implanted in 3 eyes and iatrogenic sinus occurred, we suggested them went to superior hospital. Postoperative complications: 1)lacrimal duct rupture without epiphora in 3 eyes(2.9%); 2)the duct draw out in 5 eyes(3.9%), the duct was draw and fixed to nasal vestibule, in other 4 eyes(4.9%)with fully draw out, in one of the 4, the duct was replaced and in the rest 3 of the 4, no treatment; 3)irritation symptoms at inner canthus in 11 eyes(10.8%)with symptomatic treatment; 4)granulation tissue hyperplasia in 2 eyes(2.0%), one of them near the lacrimal punctum was cut and disappeared after tobramycin dexamethasone eye drops, one in the lacrimal ductile, the duct was draw and after tobramycin dexamethasone eye drops or compound neomycin sulfate eye drops the hyperplasia did not enlarge, but the lacrimal passage irrigation was failed.

CONCLUSION:It is effective of high-frequency electric lacrimal duct plasty and annular lacrimal drainage tube implantation combined with acupuncture on upper lacrimal duct obstruction.