儿童Crawford泪道置管术治疗先天性泪道阻塞临床观察

目的观察儿童Crawfod泪道置管术治疗先天性泪道阻塞的效果。设计回顾性病例系列。研究对象一次或多次泪道探通不成功、年龄在10个月以上的先天性泪道阻塞患儿97例（136眼）。方法首先确定先天性泪道阻塞的类型。全麻下对136眼均行Crawford泪道置管术，术后常规第1天、1周及以后每个月复诊，随诊2~6个月，平均3个月。随诊时观察患儿的症状及行泪道染料排泄试验（DDT）和泪道冲洗。根据病情于术后2-6个月拆除引流管。主要指标流泪、分泌物等症状，DDT及泪道冲洗。结果治疗的136眼中，先天性单纯性泪道阻塞107眼，先天性复杂泪道阻塞22眼，后天性泪道阻塞7眼。治愈121眼（88．97％），有效13眼（9．50％），无效2眼（1．47％）。其中先天性单纯性泪道阻塞治愈率（95．32％）高于其他两组（P=0．000）。作过2次以上泪道探通（39眼）或作过其他泪道手术（8眼）者治愈率（82．05％，57．14％）低于只作过1次治疗组（89眼，95．50％）（P=0．000）。结论儿童Crawford泪道置管术是一种有效的治疗先天性泪道阻塞的方法，可作为泪道多次探通手术不成功或其他泪道置管手术不成功的补充。

Lacrimal intubation with the Crawford system in the treatment of congenital nasolacrimal duct obstruction in children

Objective To evaluate the efficacy of the Crawford lacrimal intubation surgery in treatment of congenital nasolacrimal duct obstruction in children. Design Retrospective case series. Participants Ninety-seven 10 months or older children （136 eyes） with congenital nasolacrimal duct obstruction who had failed lacrimal system probing. Methods The participants were treated with the Crawford lacrimal intubation system under general anesthesia. The patients were evaluated at 1 day, 1 week and every month after surgery. The patients were followed up between 2 and 6 months （mean 3 months）. At every follow-up visit, the clinical symptoms and signs were observed and a dye disappearance test （DDT） was also performed. The tubes were left in place between 2 and 6 months. Clinical success was defined as the relief from symptoms and signs of obstruction. Main Outcome Measures Symptoms of epiphora, secretions, DDT and lacrimal rinsing. Results Among the 136 eyes, 107 eyes had simple obstruction, 22 eyes had complex obstruction and 7 eyes had acquired obstruction. Overall results were excellent in 121 （88.97%） eyes, fair in 13 （9.50%） eyes, and poor in 2 （1.47%） eyes. The success rate was 95.32% in children with simple obstruction, which was significantly higher compared with that in children with complex obstruction or that in children with acquired obstruction （P=0.000）. The success rate was 95.50%, 82.05% and 57.14% in children who underwent single failed probing, repeated probing, and intubation respectively. The single failed probing group had a significantly higher success rate compared with the repeated probing group or intubation group （P=0.000）. Conclusions The Crawford lacrimal intubation surgery is an effective procedure for the treatment of congenital nasolaerimal duct obstruction in children and can be used as a procedure after failure of lacrimal system probing or silicone intubation.