泪道重建联合Ritleng泪道插管术治疗儿童继发性泪道阻塞

目的 评估泪道重建联合Ritleng泪道插管手术治疗儿童结膜炎后继发性泪道阻塞的效果。方法 回顾性系列病例研究。分析2008年7月至2013年12月利用泪道重建联合Ritleng泪道插管治疗的结膜炎致继发性泪道阻塞连续病例43例（49眼）的临床资料。其中男20例（23眼），女23例（26眼），年龄8个月至11岁。所有病例采用全身麻醉下泪道重建联合Ritleng泪道插管手术治疗，根据病情于术后2~6个月拔管，术后随访6～12个月。拔除泪道硅胶管后，泪道冲洗通畅为治愈，泪道冲洗通不畅并偶有流泪为好转，泪道不通为治疗无效。结果 术中探查按阻塞部位分为泪小管阻塞（9眼）、泪总管阻塞（12眼）、鼻泪管阻塞（4眼）、两处及以上部位阻塞（24眼）。拔管后治愈32眼（65%），好转10眼（20%），无效7眼（14%）。鼻腔出血及鼻翼肉芽肿为主要并发症，分别占28%、41%，对症处理后均痊愈。结论 泪道重建联合Ritleng插管技术是一种简便、安全和有效的治疗儿童结膜炎后继发性泪道阻塞的手术方法。

The effectiveness of the Ritleng lacrimal intubation system and lacrimal passage in children with acquired nasolacrimal duct obstruction

Objective To evaluate the effectiveness of the reconstruction of the lacrimal passage combined with the Ritleng intubation system in the treatment of childen′s obstruction of the lacrimal duct secondary to conjunctivitis. Methods In this retrospective cases-series study， 43 children （49 eyes） who ranged in age from 8 months to 11 years old participated. All children underwent reconstruction of the lacrimal passage combined with the Ritleng intubation system under general anesthesia. The follow-up period was from 6 to 12 months after surgery. The tubes were left in place between 2 and 6 months depending on the situation. After extubation， clinical success was defined as lacrimal patency， but sometimes there was some lacrimal resistance along with tear drainage. The surgery was considered ineffective if the tear duct was not penetrated. Results Based on the obstruction site， all the children were divided into 4 types： lacrimal canalicular obstruction （9 cases）， lacrimal duct obstruction （12 eyes）， obstruction of the nasolacrimal duct （4 eyes）， and complex duct obstruction（24 eyes）. After extubation， the overall success rate was 65%（32/49） and the melioration rate was 20%（10/49）. On the other hand， the procedure was ineffective in 7 eyes （14%）. Conclusion The reconstruction of the lacrimal passage combined with the Ritleng intubation system is a safe and effective procedure for the treatment of secondary nasolacarimal duct obstruction.