泪小管断裂经泪囊切开泪道重建术的应用

目的探讨经泪囊切开泪道置管重建术在复杂下泪小管断裂吻合术中的应用。方法 2013年1月—2016年12月重庆医科大学附二院眼科收治15例(15只眼)眼睑裂伤伴下泪小管断裂患者,修复术中不能找到鼻侧断端泪小管,采用经上泪小管定位泪囊,经创面分离切开泪囊后,将泪道引流管分别自上、下泪小点进入,下方引流管通过颞侧泪小管断端后直接进入泪囊,从鼻腔引出并打结。置管3个月后拔管,术后随访6个月,观察泪道重建术后有无溢泪症状及并发症等。结果 15例患者中8例泪道冲洗通畅,5例泪道冲洗部分冲洗液返流,无溢泪现象,另有2例患者下泪小管泪道冲洗不通,有轻微溢泪症状。结论对泪小管断裂修复术中不能找到鼻侧泪小管断端患者,采用经泪囊切开泪道置管重建术,是一种全新的手术方法,可以重建患者泪道,有效避免伤后出现溢泪症状。

The surgery of lacrimal sac incision and lacrimal duct reconstruction for treating lacrimal duct rupture

Objective To investigate the application of lacrimal passages implantation of tube reconstruc-tion through the incision of lacrimal sac in the complicated lacrimal duct rupture anastomosis .Methods A total of 15 patients (15 eyes) with eyelid laceration and lacrimal duct rupture were collected in our hospital from Jan .2013 to Dec.2016.All patients were unable to find the nasal lacrimal canaliculi after various methods during operation . Then the lacrimal sac was located by the upper lacrimal punctum ,the lacrimal sac was separated and cut open through the wound,the double-probe tear drainage tube was inserted from the upper and lower lacrimal point ,thus the lower drainage tube could directly enter the lacrimal sac through the temporal canaliculi breakage ,and finally tubes were taken out from the nasal cavity and knots were made.Extubation was carried out 3 months after catheter extubation,and postoperative follow-up lasted for 6 months to observe the symptoms of lacrimal passage reconstruc-tion after surgery,the therapy efficiency and complications.Results Among the 15 patients,8 cases had unobstr-ucted lacrimal irrigation,5 cases had no overflow of tears while flushing fluid back flow was observed during the lac-rimal duct flushing,and another 2 cases suffered from failed tear flushing along with slight symptoms of overflowing tears.Conclusion For patients in whom the broken end of naso lacrimal canaliculus can not be found in opera -tion,the lacrimal duct incision reconstruction by lacrimal sac can be used to reconstruct the lacrimal duct of the pa -tient,which can effectively prevent the symptoms of spilled tears.It is a new method of operation.