新型逆行淚道置管術(shù)治療淚道阻塞性疾病臨床治療效果及經(jīng)驗(yàn)體會(huì)
發(fā)布時(shí)間：2018-10-08 16:43
【摘要】：目的:本研究旨在探討分析采用新型逆行淚道置管術(shù)治療淚道阻塞性疾病的臨床治療效果及經(jīng)驗(yàn)體會(huì)。方法:收集2012年3月至2016年6月于大連醫(yī)科大學(xué)附屬第一醫(yī)院三部眼科確診為淚道阻塞的患者72例77眼,年齡31～76歲,中位年齡56歲,病程為6個(gè)月～20年,中位病程48月,其中男性患者19例20眼,女性患者53例57眼,男:女=1:2.74,單獨(dú)右眼患病28例,單獨(dú)左眼患病39例,雙眼患病5例。包括單純下淚小管阻塞患者6例7眼(并發(fā)淚小管結(jié)石1眼);單純淚總管阻塞患者10例11眼;鼻淚管阻塞患者39例41眼;淚小管阻塞伴鼻淚管阻塞9例10眼;淚總管阻塞伴鼻淚管阻塞8例8眼。合并慢性淚囊炎患者36例38眼,其中慢性淚囊炎急性感染后并發(fā)淚囊粘液性囊腫2例2眼、淚囊瘺管1例1眼。均行新型逆行淚道置管術(shù)治療,術(shù)后第1日起以硫酸慶大霉素氯化鈉注射液沖洗淚道,每日1次,沖洗1周;隨后沖洗淚道每周1次,沖洗4周;繼續(xù)每月沖洗淚道1次至拔管;術(shù)后予左氧氟沙星滴眼液每日4次滴術(shù)眼、鹽酸左氧氟沙星眼用凝膠每晚睡前1次涂術(shù)眼下結(jié)膜囊,共4周,視病情決定是否繼續(xù)用藥;根據(jù)患者具體情況,于術(shù)后3個(gè)月拔除置管,拔管后每月沖洗淚道1次,病情穩(wěn)定后擇期行淚道沖洗,拔管后隨訪觀察3～24個(gè)月。以拔管后末次隨訪時(shí)淚道沖洗情況結(jié)合淚溢癥狀改善情況作為評(píng)價(jià)標(biāo)準(zhǔn),總體分為有效和無(wú)效,其中有效包括治愈和顯效。結(jié)果:1.共行手術(shù)72例77眼,其中71例76眼手術(shù)過(guò)程順利,1例1眼手術(shù)失敗,手術(shù)成功率98.70%。2.除外1例1眼手術(shù)失敗患者,術(shù)后對(duì)71例76眼患者進(jìn)行隨訪,據(jù)患者末次復(fù)診情況統(tǒng)計(jì)結(jié)果,總有效率為92.10%,包括:①53例56眼于術(shù)后隨訪期間淚道沖洗通暢,均于末次復(fù)診時(shí)表示無(wú)明顯淚溢癥狀,治愈率73.68%;②12例14眼淚道沖洗通暢,但沖洗時(shí)伴有一定阻力,且均可見(jiàn)少量返流液,返流液中無(wú)明顯分泌物,于末次復(fù)診時(shí)表示偶有室內(nèi)流淚現(xiàn)象,顯效率18.42%。3.6例6眼,淚道阻塞復(fù)發(fā),無(wú)效率為7.90%,其中5眼術(shù)前伴有不同程度的慢性淚囊炎。4.對(duì)不同類型淚道阻塞手術(shù)療效對(duì)比分析χ2值為5.077,P=0.279,認(rèn)為不同類型淚道阻塞手術(shù)治療有效率之間無(wú)統(tǒng)計(jì)學(xué)意。5.對(duì)術(shù)前是否合并慢性淚囊炎進(jìn)行療效對(duì)比分析χ2值為2.895,P=0.089,差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1.新型淚道逆行置管術(shù)以特制的淚道探針準(zhǔn)確地將淚道引流管從隱蔽的鼻淚管下口置入淚道,有效解決了以往置管術(shù)中的難點(diǎn),手術(shù)成功率高。2.新型淚道逆行置管術(shù)配合后續(xù)淚道沖洗,操作簡(jiǎn)單且術(shù)后并發(fā)癥少,對(duì)淚道阻塞及慢性淚囊炎具有肯定的療效,是一種適于廣泛推廣的淚道微創(chuàng)療法。3.術(shù)前嚴(yán)格掌握手術(shù)適應(yīng)癥以及排除相關(guān)疾病是手術(shù)成功的必要條件。4.不同類型淚道阻塞經(jīng)手術(shù)治療后療效之間差異無(wú)統(tǒng)計(jì)學(xué)意義,需進(jìn)一步擴(kuò)大樣本研究。5.術(shù)前伴有慢性淚囊炎的患者術(shù)后淚道阻塞復(fù)發(fā)例數(shù)更多,但差異無(wú)統(tǒng)計(jì)學(xué)意義,需進(jìn)一步擴(kuò)大樣本研究。6.該手術(shù)方法對(duì)慢性淚囊炎導(dǎo)致的淚囊粘液囊腫的治療效果欠佳,對(duì)于此類患者應(yīng)考慮其他手術(shù)方式治療。
[Abstract]:Objective: The purpose of this study is to investigate the clinical therapeutic effect and experience of the novel retrograde lacrimal passage in the treatment of lacrimal passage obstructive disease. Methods: 72 patients with lacrimal obstruction were collected from March 2012 to June 2016 at the First Affiliated Hospital of Dalian Medical University, with age of 31 ~ 76 years old, middle age 56 years old, course of 6 months ~ 20 years, middle position course in 48 months, among them 19 patients with 20 eyes, Fifty-five female patients (57 eyes), male: female = 1: 2.74, right eye disease (28 cases), left-eye disease (39 cases) and bilateral eyes (5 cases). There were 6 7 eyes (1 eyes complicated with small lacrimal duct stone) in the patients with simple lower lacrimal duct obstruction, 10 cases of lacrimal duct obstruction, 39 patients with nasolacrimal duct obstruction, 9 cases with lacrimal duct obstruction with nasolacrimal duct obstruction, 8 eyes blocked with nasolacrimal duct obstruction with nasolacrimal duct obstruction. Thirty-eight eyes of 36 patients with chronic dacryocystitis were combined, including 2 cases of chronic dacryocystitis after acute infection, 2 eyes in lacrimal sac mucinous cyst, and 1 eye in lacrimal sac. All the patients were treated with a new type of retrograde lacrimal passage, and the lacrimal passage was flushed with gentamicin sulfate sodium chloride injection on the 1st day of the operation, once a day for 1 week, followed by flushing the lacrimal passage once a week for 4 weeks, and continuously flushing the lacrimal passage once a month for one time to the extubation; After the operation, the left ofloxacin eye drops were administered 4 times a day, and the left ofloxacin eye gel was applied to the conjunctival sac once every night for 4 weeks to determine whether to continue the administration according to the condition of the patient; according to the specific condition of the patient, a tube was pulled out for 3 months after operation, After extubation, the lacrimal passage was washed once a month. After the condition was stable, the lacrimal passage was washed, and the follow-up observation was observed for 3-24 months after extubation. In the last follow-up at the end of extubation, the improvement of lacrimal passage was considered as an evaluation criterion, which was divided into effective and ineffective, among which the cure and the effect were effectively included. Result: 1. 72 cases of 77 eyes were operated in total, of which 71 cases had smooth operation, 1 case had failed operation, and the success rate was 98. 70%. The total effective rate was 92.9% in 71 patients with 76 eyes, except 1 case with 1 eye surgery. The total effective rate was 92. 10%. The cure rate was 73. 68%, while in 12 patients with 14 tears, there was a certain resistance. There was no obvious secretion in the back flow. There was no obvious secretion in the return fluid. In the end of the last visit, there was no obvious secretion. The effective rate was 18. 42%. In 6 eyes, the lacrimal passage blocked the recurrence with no efficiency of 7. 90%. Of which 5 eyes were accompanied by a different degree of chronic dacryocytis. The comparative analysis of the curative effect of different types of lacrimal duct obstruction was 5. 077, P = 0. 279. There was no difference in the effective rate between different types of lacrimal duct obstruction. There was no significant difference in the curative effect between the patients with chronic dacryocytis before and after the operation, the difference was 2. 895, P = 0.089, and the difference was not statistically significant. Conclusion: 1. A new lacrimal passage method is used to accurately place the lacrimal drainage tube from the concealed nasolacrimal duct into the lacrimal passage through a special lacrimal passage probe, thereby effectively solving the difficulties in the prior art, and the operation is simple. the novel lacrimal passage retrograde pipe operation is matched with the subsequent lacrimal passage for flushing, has simple operation and few postoperative complications, has definite curative effect on the obstruction of the lacrimal passage and the chronic dacryocytis, and is a lacrimal passage micro-wound therapy suitable for wide popularization. Intraoperative strict mastery of surgical indications and exclusion of related diseases is a necessary condition for the success of surgery. 4. There was no significant difference in the efficacy of different types of lacrimal duct obstruction after operation, and the sample study was further expanded. There were more patients with chronic dacryocystitis after operation, but there was no statistical significance in the difference. The surgical method has poor curative effect on lacrimal sac mucocele caused by chronic dacryocystitis, and other surgical methods should be considered for such patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
本文編號(hào)：2257508
[Abstract]:Objective: The purpose of this study is to investigate the clinical therapeutic effect and experience of the novel retrograde lacrimal passage in the treatment of lacrimal passage obstructive disease. Methods: 72 patients with lacrimal obstruction were collected from March 2012 to June 2016 at the First Affiliated Hospital of Dalian Medical University, with age of 31 ~ 76 years old, middle age 56 years old, course of 6 months ~ 20 years, middle position course in 48 months, among them 19 patients with 20 eyes, Fifty-five female patients (57 eyes), male: female = 1: 2.74, right eye disease (28 cases), left-eye disease (39 cases) and bilateral eyes (5 cases). There were 6 7 eyes (1 eyes complicated with small lacrimal duct stone) in the patients with simple lower lacrimal duct obstruction, 10 cases of lacrimal duct obstruction, 39 patients with nasolacrimal duct obstruction, 9 cases with lacrimal duct obstruction with nasolacrimal duct obstruction, 8 eyes blocked with nasolacrimal duct obstruction with nasolacrimal duct obstruction. Thirty-eight eyes of 36 patients with chronic dacryocystitis were combined, including 2 cases of chronic dacryocystitis after acute infection, 2 eyes in lacrimal sac mucinous cyst, and 1 eye in lacrimal sac. All the patients were treated with a new type of retrograde lacrimal passage, and the lacrimal passage was flushed with gentamicin sulfate sodium chloride injection on the 1st day of the operation, once a day for 1 week, followed by flushing the lacrimal passage once a week for 4 weeks, and continuously flushing the lacrimal passage once a month for one time to the extubation; After the operation, the left ofloxacin eye drops were administered 4 times a day, and the left ofloxacin eye gel was applied to the conjunctival sac once every night for 4 weeks to determine whether to continue the administration according to the condition of the patient; according to the specific condition of the patient, a tube was pulled out for 3 months after operation, After extubation, the lacrimal passage was washed once a month. After the condition was stable, the lacrimal passage was washed, and the follow-up observation was observed for 3-24 months after extubation. In the last follow-up at the end of extubation, the improvement of lacrimal passage was considered as an evaluation criterion, which was divided into effective and ineffective, among which the cure and the effect were effectively included. Result: 1. 72 cases of 77 eyes were operated in total, of which 71 cases had smooth operation, 1 case had failed operation, and the success rate was 98. 70%. The total effective rate was 92.9% in 71 patients with 76 eyes, except 1 case with 1 eye surgery. The total effective rate was 92. 10%. The cure rate was 73. 68%, while in 12 patients with 14 tears, there was a certain resistance. There was no obvious secretion in the back flow. There was no obvious secretion in the return fluid. In the end of the last visit, there was no obvious secretion. The effective rate was 18. 42%. In 6 eyes, the lacrimal passage blocked the recurrence with no efficiency of 7. 90%. Of which 5 eyes were accompanied by a different degree of chronic dacryocytis. The comparative analysis of the curative effect of different types of lacrimal duct obstruction was 5. 077, P = 0. 279. There was no difference in the effective rate between different types of lacrimal duct obstruction. There was no significant difference in the curative effect between the patients with chronic dacryocytis before and after the operation, the difference was 2. 895, P = 0.089, and the difference was not statistically significant. Conclusion: 1. A new lacrimal passage method is used to accurately place the lacrimal drainage tube from the concealed nasolacrimal duct into the lacrimal passage through a special lacrimal passage probe, thereby effectively solving the difficulties in the prior art, and the operation is simple. the novel lacrimal passage retrograde pipe operation is matched with the subsequent lacrimal passage for flushing, has simple operation and few postoperative complications, has definite curative effect on the obstruction of the lacrimal passage and the chronic dacryocytis, and is a lacrimal passage micro-wound therapy suitable for wide popularization. Intraoperative strict mastery of surgical indications and exclusion of related diseases is a necessary condition for the success of surgery. 4. There was no significant difference in the efficacy of different types of lacrimal duct obstruction after operation, and the sample study was further expanded. There were more patients with chronic dacryocystitis after operation, but there was no statistical significance in the difference. The surgical method has poor curative effect on lacrimal sac mucocele caused by chronic dacryocystitis, and other surgical methods should be considered for such patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
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