李道远,冯秉民,刘兴德
LI Daoyuan,FENG Bingmin,LIU Xingde

• 1:贵州医科大学眼科学教研室

摘要(Abstract)：

目的:观察非内窥镜下Crawford管置管术治疗泪道阻塞的临床效果。方法:160例(180眼)泪道阻塞性患者,采用非内窥镜下Crawford管置管术进行治疗,患者拔管后随诊3个月,比较不同发病部位(泪点膜闭、泪小管阻塞、泪总管阻塞、泪囊黏液囊肿及鼻泪管阻塞)、不同发病时间(≤2年、>2年)及不同发病年龄(≤40岁、>40岁)患眼的治疗效果。结果:180眼中治愈130眼(72.22%),好转23眼(12.78%),无效19眼(10.56%),复发8眼(4.44%);泪小点膜闭、泪小管阻塞、泪总管阻塞的治愈率显著高于泪囊黏液和鼻泪管阻塞患者(P<0.05),短病史组患眼的治愈率显著高于长病史组(P=0.001),年龄对治疗效果无影响(P=0.771);满意度调查发现63.7%以上患者对置管治疗后眼外观、舒适性、自觉症状及生活质量的提高等方面均比较满意。结论:非内窥镜下Crawford管置管术是一种治疗泪小管阻塞的有效方法。
Objective: To analyze the effect of lacrimal duct obstruction through Crawford tube catheterization independent of nasal endoscopy.Methods:160 casespatients(180 eyes) with lacrimal duct obstruction were treated with Crawford tube catheterization independent of nasal endoscopy.Follow-up for three months,comparing the location of lacrimal duct obstruction(lacrimal canaliculi closure,lacrimal canaliculi obstruction,lacrimal duct obstruction,dacryocyst mucocele and nasolacrimal duct obstruction),time of onset(≤2 years,>2 years) and efficacy in different age of onset.Results:Among 180 eyes,130 eyes were successfully cured(72.22%),23 eyes were improved(12.78%),19 eyes were ineffective(10.56%),eight eyes relapsed(4.44%).Additionally,patients with lacrimal canaliculi closure,lacrimal canaliculi obstruction,lacrimal duct obstruction showed higher cure rate than dacryocyst mucocele and nasolacrimal duct obstruction(P<0.05).Short term disease group cure rate was higher than that of long term group(P=0.001); age showed no influence on treatment efficacy(P=0.771); satisfaction survey indicated that over 63.7% patients were satisfied with out-appearance,comfortableness,subjective symptom and improved life quality after surgery.Conclusion:Crawford tube catheterization independent of nasal endoscopy is an effective method for the treatment of lacrimal canaliculi obstruction.

关键词(KeyWords)： crawford管;泪道阻塞;微创,非内窥镜;鼻泪道阻塞;泪囊黏液囊肿
crawford tube;lacrimal duct obstruction;minimally invasive surgery,non-endoscopic;nasolacrimal duct obstruction;dacryocyst mucocele

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(31760294);; 贵州省科技合作计划项目[黔科合LH字(2015)7388];; 贵州省教育厅科技人才成长项目[黔教合KY字(2018)186];; 贵州医科大学2018年度学术新苗培养及创新探索专项项目[黔科合平台人才(2018)5779-28];; 贵州省科技厅科技平台及人才团队计划[黔科合平台人才(2018)5608];; 贵州省科学技术基金计划[黔科合基础(2016)1120]

作者(Author): 李道远,冯秉民,刘兴德
LI Daoyuan,FENG Bingmin,LIU Xingde

DOI: 10.19367/j.cnki.1000-2707.2019.08.014

参考文献(References)：

• [1] DANATAS R R.Lacrimal drainage system obstruction[J].Seminars in ophthalmology,2010,25(3):98-103.
• [2] KACANIKU G,AJAZAJ V,SHABANNI A,et al.Assessing the usefulness of different silicone tubes in external dacryocystorhinostomy[J].Medical Archives,2018,72(6):414-417.
• [3] EUSTIS H S,NGUYEN A H.The treatment of congenital nasolacrimal duct obstruction in children:a retrospective review[J].Journal of Pediatric Ophthalmology and Strabismus,2018,55(1):65-67.
• [4] NELAON L B.Treatment of congenital nasolacrimal duct obstruction[J].Journal of Pediatric Ophthalmology and Strabismus,2016,53(5):270.
• [5] KABATA Y,GOTO S,TAKAHASHI G,et al.Vision-related quality of life in patients undergoing silicone tube intubation for lacrimal passage obstructions[J].American Journal of Ophthalmology,2011,152(1):147-150.
• [6] XU J,HONG J,SUN X,et al.Combined lacrimal passage probing and tobramycin/dexamethasone ophthalmic ointment infiltration:a minimally invasive surgical procedure for incomplete nasolacrimal duct obstruction[J].Medicine,2015,94(36):e1483.
• [7] XIANG Q,HU D,GAO X.Tobramycin/dexamethasone eye drops as a better choice for lacrimal duct probing in persistent congenital nasolacrimal duct obstruction:a consort study[J].Medicine,2019,98(6):e14188.
• [8] MIMURA M,UEKI M,OKU H,et al.Evaluation of granulation tissue formation in lacrimal duct post silicone intubation and its successful management by injection of prednisolone acetate ointment into the lacrimal duct[J].Japanese Journal of Ophthalmology,2016,60(4):280-285.
• [9] BAEK J S,JEONG S H,LEE J H,et al.Cause and management of patients with failed endonasal dacryocystorhinostomy[J].Clinical and Experimental Otorhinolaryngology,2017,10(1):85-90.
• [10]RAGHUWANSHI S K,RAGHUWANSHI S,AGARWAL M,et al.Primary endonasal DCR without stent:our experience and case series analysis[J].Indian Journal of Otolaryngology and Head and Neck Surgery:Official Publication of The Association of Otolaryngologists of India,2015,67(3):271-274.
• [11]JAWAHEER L,MACEWEN C J,ANIJEET D.Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction[J].The Cochrane Database of Systematic Reviews,2017(2),2:Cd007097.
• [12]MARFATIA H,SHAH K,MADHAVI A,PARMAR Y.Paediatric endonasal dacryocystorhinostomy using an otology set:How I do it[J].International Journal of Pediatric Otorhinolaryngology,2017(10),101:211-214.
• [13]ALI M J,PAULSEN F.Human lacrimal drainage system reconstruction,recanalization,and regeneration[J].Current Eye Research,2019(2):1-12.
• [14]LIN L,YANG L,JIN X,et al.Management lacrimal sac abscesses using lacrimal probe and crawford silicon tube[J].BMC Ophthalmology,2016,16(1):211.
• [15]KALIN-HAJDU E,CADET N,BOULOS P R.Controversies of the lacrimal system[J].Survey of Ophthalmology,2016,61(3):309-313.

文章评论(Comment)：