目的 探讨经上泪小点注入玻璃酸钠凝胶定位下泪小管鼻侧断端的可行性.方法 收集2013年3月至2016年3月在南昌大学第三附属医院行下泪小管断端吻合联合置管术的下泪小管断裂患者52例52眼.术中以上泪小点注入玻璃酸钠凝胶定位下泪小管鼻侧断端者为A组(32例32眼),显微镜直视下寻找鼻侧断端者为B组(20例20眼),定位鼻侧断端后以硅胶管倒“U”形置入泪道.硅胶管在泪道内留置大于3个月后拔管,术后随访6～12(8.2±1.6)个月,比较2组下泪小管断端的距离、定位鼻侧断端的时间,手术有效率及并发症等.结果 所有患者术中均找到下泪小管鼻侧断端并成功吻合.A组23例治愈,5例好转,4例失败,其中3例上或下泪小点撕裂;B组13例治愈,4例好转,3例失败,其中2例上泪小点或下泪小点撕裂.A组下泪小管断端与下泪小点距离为6.5 ～8.3(7.3±0.6) mm,与B组的6.6 ～8.2(7.2±0.5)mm相比差异无统计学意义(P=0.40);A组定位下泪小管鼻侧断端所需时间为1.5～5.5(3.3±1.3) min,B组为5.0 ～26.0(17.0±6.0) min,A组显著短于B组,差异有统计学意义(P ＜0.001).结论 下泪小管断端达内眦部时,鼻侧断端很难快速准确定位,应用上泪小点注入玻璃酸钠凝胶法,可以快速、准确定位鼻侧断端,此方法简单、易行,可明显缩短手术时间.%Objective To investigate the feasibility of injection of sodium hyaluronate gel to upper lacrimal puncta in locating the nasal broken end of inferior canalicular laceration.Methods Together 52 patients(52 eyes) with inferior canalicular laceration who collected from March 2013 to March 2016 in the Third Affiliated Hospital of Nanchang University underwent canaliculax laceration anastomosis combined with silicone tube.Injection of sodium hyaluronate gel to the upper lacrimal puncta was introduced in group A (n =32/32 eyes) for locating the nasal broken end of lower canaliculax laceration,while microscope for searching the nasal broken end served as group B (n =20/20 eyes).In both groups,the silicone tubes were implanted in the lacrimal passage for more than 3 months after locating the broken end successfully.All patients were followed up from 6 months to 12 months,with mean follow-up of (8.2 ± 1.6) months,and then clinical data of the distance of lower canalicular laceration between lacrimal canal,time consuming for locating the nasal broken end,effective rate and postoperative comphcations were compared between two groups.Results The procedures in all patients were successfully.In group A,23 patients were cured and 5 improved,but the operation was failed in 4 patients,of which 3 patients occurred upper or lower lacrimal punctas teax;while in group B,13 patients were cured and 4 improved,but the operation was failed in 3 patients,of which 2 patients occurred upper or lower lacrimal punctas tear.There was no significant difference in the the distance of between lower canalicular laceration and lacrimal canal in group A [6.5-8.3 (7.3 ± 0.6) mm] and group B [6.6-8.2 (7.2 ± 0.5) mm] (P =0.40).The time consuming for locating the nasal broken end in group A [1.5-5.5 (3.3 ± 1.3) min] was shorter than that in group B [5.0-26.0 (17.0 ± 6.0) min],with significant difference (P ＜ 0.001).Conclusion It is an easy and accurate method of injection of sodium hyaluronate gel to upper lacrimal puncta for locating the nasal broken end of lower canalicular laceration with less time.
展开▼
