本文選題：硬化劑 + 新型淚道成形器�。� 參考：《天津醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的 慢性淚道阻塞和淚囊炎是眼科的常見病,同時(shí)又是眼內(nèi)手術(shù)前必須消除的疾病。本研究包括兩部分：第一部分是探索一種快速微創(chuàng)治療淚囊炎的方法的實(shí)驗(yàn)研究,取代淚囊摘除術(shù)。第二部分使用擁有自主知識(shí)產(chǎn)權(quán)的專利產(chǎn)品對(duì)慢性淚道阻塞和淚囊炎患者進(jìn)行全淚道鉆切成形術(shù)的回顧性臨床研究。 對(duì)象方法 1.選擇新西蘭大白兔為實(shí)驗(yàn)動(dòng)物,將7只白兔隨機(jī)分成對(duì)照組(1只兔)平陽(yáng)霉素組簡(jiǎn)稱“平陽(yáng)組”(6只左眼)、磷霉素鈉葡萄糖組簡(jiǎn)稱“磷葡組”(6只右眼)。對(duì)照組藥物為0.9%的生理鹽水；平陽(yáng)組藥物為平陽(yáng)霉素、地塞米松、利多卡因、0.9%的生理鹽水；磷葡組藥物為磷霉素鈉粉、50%葡萄糖。對(duì)白兔淚道按照淚道沖洗操作規(guī)范分別注入上述藥物,在給藥后1周、2周兩個(gè)不同時(shí)間段解剖分離出淚囊并觀察其組織病理形態(tài)學(xué)變化。 2.回顧性病例研究,收集2006年8月至2009年1月在天津醫(yī)科大學(xué)總醫(yī)院眼科門診治療的90例(90只眼),其中慢性淚道阻塞40眼,慢性淚囊炎43眼,急性淚囊炎7眼,對(duì)淚道沖洗探通及激光治療失敗的患者局麻下行“經(jīng)淚小點(diǎn)全淚道鉆切成形術(shù)”治療。患者年齡范圍22歲到86歲,平均53歲。隨訪時(shí)間為3-32個(gè)月,平均隨訪時(shí)間10個(gè)月。對(duì)該方法治療慢性淚道阻塞、急性和慢性淚囊炎的療效、術(shù)中術(shù)后并發(fā)癥及影響療效的因素進(jìn)行分析。 結(jié)果 1.對(duì)照組無(wú)明顯變化,淚道黏膜為柱狀上皮,結(jié)構(gòu)基本正常；給藥后1周平陽(yáng)組淚道沖洗通暢,淚道黏膜水腫、增生,有炎癥細(xì)胞浸潤(rùn)；磷葡組淚道沖洗不通暢,黏膜水腫、增生、炎癥細(xì)胞浸潤(rùn)；給藥后2周平陽(yáng)組淚道沖洗通暢、淚道黏膜上皮細(xì)胞增生結(jié)構(gòu)紊亂、少量上皮細(xì)胞內(nèi)陷入軟組織中、炎癥細(xì)胞浸潤(rùn)；磷葡組淚囊組織炎性細(xì)胞浸潤(rùn)、黏膜上皮細(xì)胞大部分缺失、淚囊腔內(nèi)可見血液和膠原滲出,淚囊腔狹窄,淚囊明顯萎縮,與周圍組織未見明顯粘連。 2.“經(jīng)淚小點(diǎn)全淚道鉆切成形術(shù)”(TPLD)后77只眼(85.6%)治愈,9只眼(10%)好轉(zhuǎn),4只眼(4.4%)淚道沖洗不通暢。術(shù)中及術(shù)后并發(fā)癥包括下瞼皮膚腫脹淤血、18只眼(20%)脫管、4只眼(4.4%)發(fā)生淚小管撕裂。43例慢性淚囊炎患者中33只眼(76.7%)治愈,7只眼(16.3%)好轉(zhuǎn),3只眼(7.0%)沖洗淚道不通暢。急性淚囊炎7例均在2-3周內(nèi)消腫,5例淚道沖洗通暢,淚囊膿液消失,2例擠壓淚囊仍有少量膿液。 結(jié)論 1.磷霉素鈉葡萄糖淚道注射硬化療法對(duì)實(shí)驗(yàn)性兔淚道有較好的閉塞作用,2周即可導(dǎo)致淚囊萎縮,效果優(yōu)于平陽(yáng)霉素。磷霉素鈉主要由膠原纖維增生導(dǎo)致管壁增厚、副作用小、并發(fā)癥少,考慮到高滲糖和磷霉素鈉都可在人體內(nèi)重吸收,不但硬化效果好,而且殘留少、無(wú)刺激,磷霉素鈉還有防治細(xì)菌感染作用,臨床上尤其適用于合并全身并發(fā)癥無(wú)法實(shí)施或不愿意手術(shù)的老年慢性淚囊炎患者,有著重要的臨床應(yīng)用價(jià)值。 2.“經(jīng)淚小點(diǎn)全淚道鉆切成形術(shù)”(TPLD)治療淚道阻塞性疾病療效確切,其中治療慢性淚道阻塞療效優(yōu)于慢性淚囊炎。同時(shí)患者良好的依從性及規(guī)律的術(shù)后沖洗護(hù)理對(duì)手術(shù)療效起著至關(guān)重要的作用�！靶滦蜏I道成形器”(LDST)是種便捷、安全、經(jīng)濟(jì)的手術(shù)器械,手術(shù)方法容易被眼科醫(yī)師所掌握,適合在廣大基層醫(yī)院尤其是邊遠(yuǎn)地區(qū)推廣應(yīng)用。
[Abstract]:objective
Chronic lacrimal duct obstruction and dacryocystitis are common diseases in the ophthalmology and must be eliminated before intraocular surgery. This study includes two parts: the first part is to explore an experimental study of a rapid and minimally invasive treatment of dacryocystitis, instead of dacryocyst extirpation. The second part uses patent products with independent intellectual property rights to chronic tears. Retrospective clinical study of total lacrimal duct drilling for patients with obstruction and dacryocystitis.
Object method
1. the New Zealand white rabbits were selected as the experimental animals, and 7 rabbits were randomly divided into the control group (1 rabbits), the Pingyang mycophencin group was referred to as "Pingyang group" (6 left eyes), and the phosphamycin sodium glucose group was referred to as "the phosphorus group" (6 right eyes). The control group was 0.9% of the saline, and the Pingyang group was Pingyang mycin, dexamethasone, lidocaine, 0.9%. The medicine of group phosphorus was fosfomycin sodium powder and 50% glucose. The white rabbit lacrimal duct was injected into the lacrimal duct according to the standard of lacrimal duct rinsing operation. The lacrimal sac was dissected at 1 weeks after the administration and 2 weeks at two different periods, and the histopathological changes were observed.
2. retrospective case studies were conducted to collect 90 cases (90 eyes) in the ophthalmology department of General Hospital Affiliated to Tianjin Medical University from August 2006 to January 2009, of which 40 eyes were blocked by chronic lacrimal duct obstruction, 43 eyes of chronic dacryocystitis, 7 eyes of acute dacryocystitis, and "teardrop total lacrimal passage drilling" under local anesthesia for lacrimal duct flushing and laser treatment. The patients were aged from 22 to 86 years old, with an average of 53 years of age. The follow-up time was 3-32 months and the average follow-up time was 10 months. The treatment of chronic lacrimal duct obstruction, acute and chronic dacryocystitis, postoperative complications and factors affecting the effect were analyzed.
Result
There was no obvious change in the 1. control group. Lacrimal duct mucosa was columnar epithelium and the structure was normal. The lacrimal duct was flushed and smooth in Pingyang group 1 weeks after administration. The mucous membrane of lacrimal duct was edema, hyperplasia and infiltration of inflammatory cells. The lacrimal passage was flushed without patency, mucous edema, hyperplasia and infiltration of inflammatory cells. The lacrimal duct of the Pingyang group was flushed and smooth and mucous epithelium of lacrimal passage after 2 weeks of administration. The cell proliferation was in disorder, a small amount of epithelial cells were trapped in soft tissue, inflammatory cells infiltrated, inflammatory cells infiltrated in the lacrimal sac tissue, most of the mucous epithelial cells were missing, the blood and collagen exudation were found in the lacrimal sac cavity, the lacrimal sac cavity was narrow, the dacryocyst atrophied obviously, and no obvious adhesion was found in the circumference tissue.
2. "TPLD", 77 eyes (85.6%) were cured, 9 eyes (10%) improved, 4 eyes (4.4%) unobstructed lacrimal passage. Complications included swelling and congestion of the lower eyelid skin, 18 eyes (20%), 4 eyes (4.4%) tear ducts, 4 eyes (76.7%) in patients with chronic dacryocystitis, and 85.6% eyes (76.7%) cured, 4 eyes (76.7%) cured, 4 eyes (76.7%) cured, 7 eyes (76.7%) 6.3%) improvement, 3 eyes (7%) flushing lacrimal duct unobstructed. 7 cases of acute dacryocystitis all disappeared within 2-3 weeks, 5 cases of lacrimal duct flushed, lacrimal sac pus disappeared, 2 cases of squeezing lacrimal sac still had a small amount of pus.
conclusion
1. fosfomycin sodium glucose lacrimal duct injection hardening therapy has a better occlusion effect on experimental rabbit lacrimal duct. It can cause dacryocyst atrophy in 2 weeks. The effect is better than that of Pingyang mycophencin. The effect of sclerotherapy is good, and the residue is little, no stimulation, and fosfomycin sodium has the effect of preventing bacterial infection. It is especially suitable for the elderly patients with chronic dacryocystitis which can not be implemented or would not be willing to be operated on.
2. "TPLD" is effective in the treatment of lacrimal duct obstruction, and the treatment of chronic lacrimal duct obstruction is better than chronic dacryocystitis. The good compliance and regular postoperative nursing care of the patients plays a vital role in the surgical effect. "New LDST" is a kind of convenience, Safe, economical surgical instruments and surgical methods are easy to be grasped by ophthalmologists. They are suitable for popularization and application in the grass-roots hospitals, especially in remote areas.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.6

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