外伤性泪小管断裂吻合手术的远期效果

目的探讨外伤所致的泪小管断裂的吻合手术方法，并观察其远期效果。方法对63例外伤性泪小管断裂，在手术显微镜下采用直接寻找插管法（45例）或上泪点注液法（18例）发现泪小管鼻侧断端进行吻合。术后1—2个月拔管。随访1—3年，观察远期泪小管通畅程度、内眦部愈合及并发症的情况。对两种不同的手术方法的治愈率进行比较。结果远期治愈率：直接寻找插管法45例中治愈35例，好转7例，治愈率为77．78％，总有效率93．33％；上泪点注液法18例中治愈11例，好转4例，治愈率为61．11％，总有效率83．33％。主要并发症为下泪点撕裂18例（28．57％）及内眦切迹2例（3．17％）。结论直接寻找插管法治疗泪小管断裂远期效果良好，上泪点注液法次之。但二者的总有效率差异无统计学意义（X^2=3．84P〉0．05）。远期主要并发症为下泪点撕裂。

Long-term follow-up result of surgical anastomosis for traumatic lacrimal canalicular lacerations

Objective To study the anastomotic methods of traumatic canalicular lacertions and observe its long-term follow-up result. Methods The of 63 cases traumatic canalicular lacerations of 63 casee were anastomosed at the canalicular nasal broken ends which were found by direct intubaing method (45 cases) or the upper lacrimal punctum irrigating method ( 18 cases)under the operating microscope. The inserted stents were removed in 1 ～ 2 months after the operation. The postoperative curative rate between these two methods were compared. We observed the patency of the lacrimal canaliculus, the healing of the inner canthus and the postoperative complications over the follow-up of 1 ～ 3 years. Results The long-term curative rate was 77.87％ (35/45)and the total effective rate was 93.33％ (42/45)by direct intubaing method,and 61.00％ (11/18) and 83.33％ (15/18) by the uppr lacrimal punctum irrigating method. The main complications were lower lacrimal punctum proximal lacerations ( 18 eyes,28.57％ )and the inner canthus notch (2 eyes,3.17％ ). Conclusions The long-term effects of surgical anastomosis for lacrimal canalicular lacerations with searching by direct intubaing method and the upper lacrimal punctum irrigating method are satisfactory. The main long-term complications are lower lacrimal punctum proxinal lacerations.