Fr2型硅胶管双路环形置入治疗泪道阻塞效果的影响因素

目的 分析Fr2型硅胶管双路环形置入治疗泪道阻塞的效果。设计  回顾性病例系列。研究对象  泪道阻塞患者332例394眼。方法 根据患者情况，将其分为单节段阻塞（257例）与多节段阻塞（137例），泪小管/泪总管阻塞（164例）与鼻泪管阻塞（83例），合并慢性泪囊炎（57例）与不合并慢性泪囊炎（26例），术前无探通、探通<5次、5~10次、＞10次，单纯义管植入与激光泪道成形联合义管植入，术后泪道冲洗＞4次/月、1~4次/月、＜1次/月，拔管时间<6周、6周~<3个月、3~6个月、＞6个月，首次手术与非首次手术。所有患者行Fr2型硅胶管双路环形置入治疗，分别比较不同患者的置管有效率。疗效评价依据为患者溢泪主诉、拔管后1个月泪道冲洗结果及有无并发症。 主要指标 置管有效率。结果 泪道阻塞置管总有效率为87%，单节段性阻塞（92.61%）比多节段性阻塞（75.91%）置管有效率高（χ2＝21.741，P＝0.001）；泪小管/泪总管阻塞（92.07%）的置管有效率优于鼻泪管阻塞（84.34%）（χ2＝3.502，P＝0.047）；合并慢性泪囊炎者（87.72%）较不伴有慢性泪囊炎者（76.92%）置管有效率无统计学差异（χ2＝1.576，P＝0.175）；随术前探通次数增加，置管有效率显著下降（χ2＝30.252，P＝0.000）；YAG激光泪道成形联合义管植入在泪小管/泪总管阻塞的置管有效率高于单纯置管（χ2＝6.505，P＝0.012）；术后泪道冲洗1~4次/月者（90.10%）较冲洗＞4次/月者（85.50%）和冲洗＜1次/月者（74.47%）置管有效率高（χ2＝8.219，P＝0.016）；6周~<3个月拔管者（91.63%）和3~6个月者（88.16%）置管有效率优于拔管时间<6周者（47.62%）和拔管时间＞6个月者（66.67%）（χ2＝38.880，P＝0.000）；二次手术置管有效率明显低于初次手术（χ2＝15.548，P＝0.006）。结论 明确Fr2型泪道引流管的置管手术适应证、减少术前破坏性的泪道探通次数、采用创伤更小的YAG激光泪道成形联合泪道义管植入术、术后适量的泪道冲洗和严格把握拔管时间，是泪道义管植入手术成功率提高的有效方法。（眼科， 2016, 25： 409-413）

Influence factors of Fr2 double-passage silicone intubation for lacrimal duct obstruction

Objective To evaluate associations of the success rate of Fr2 silicone intubation for lacrimal duct obstruction. Design Retrospective case series. Participants 332 lacrimal duct obstruction cases (394 eyes). Methods 332 lacrimal duct obstruction cases (394 eyes) were analyzed based on obstructed severity and location, with dacryocystitis or not, previous probing, the operational method, the post-operative irrigation, the timing of silicone tube removal and the number of operations. The success rate of Fr2 silicone intubation was assessed based on the complaints of the patient, the silicone tube removal at post-operative 1 month and the presence of complications. Main Outcome Measures The success rate of silicone intubation. Results Total success rate of intubation was 87%, among which the success rate for the mono-segmental blocking group (n=257) was 92.61%, while it was only 75.91% in the multi-segmental occlusion group (n=137) (χ2＝21.741, P＝0.001 ). The effective rate of intubation in the canaliculusocclusional cases (92.07%) was higher than in the nasolacrimal occlusional cases(84.34%) (χ2＝3.502, P＝0.047). There is no significant difference in effective rate for the nasolacrimal occlusional cases with chronic dacryocystitis (87.72%) and for the cases without dacryocystitis (76.92%) (χ2＝1.576, P＝0.175). With the increase number of pre-operative probing, the efficiency of intubation decreased (χ2＝30.252, P<0.001). The efficiency was only 64.92% in cases with pre-operative probing more than 10 (P<0.05). YAG lacrimal duct formation combined silicone intubation was better than simple silicone intubation in obstruction of canaliculus (χ2＝6.505, P＝0.012). The effective rate was 90.10% in the irrigation1~4/mon group but it was 85.50% in the irrigation ＞4/mon group and 74.47% in the irrigation ＜1/mon group (χ2＝8.219, P＝0.016). Early (<6 weeks, 47.62%) or late (＞6 months, 66.67%) tube removal significantly reduced catheter intubation efficiency (91.63% in the 6 weeks to 3 months group and 88.16% in the 3 to 6 months group) (χ2＝38.880, P＝0.000). The effective rate for the first-surgery group was higher than that of reoperation cases (χ2＝15.548, P＝0.006). Conclusion The obstructed severity, obstructed location, chronic dacryocystitis, pre-operational probing, post-surgery irrigation and the extubation time affect the success rate of Fr2 intubation. YAG lacrimal duct formation combined silicone intubation is better than simple silicone intubation in obstruction of lacrimal canaliculus. (Ophthalmol CHN, 2016, 25: 409-413)