人工鼻泪道管植入治疗急性泪囊炎的临床观察

刘云芳　杨卫华浙江省湖州市第一人民医院眼科，浙江湖州　313000

人工鼻泪道管植入治疗急性泪囊炎的临床观察

刘云芳杨卫华▲
浙江省湖州市第一人民医院眼科，浙江湖州313000

目的探讨人工鼻泪道管植入治疗急性泪囊炎的临床疗效。 方法收集2012年4月～2014年8月在我院治疗的急性泪囊炎患者48眼，随机分为两组，观察组28眼给予泪小管探通引流，采用人工鼻泪道管植入术，术前及术后给予全身及局部常规抗感染治疗。对照组20眼，行皮肤切开排脓、抗感染治疗后采用传统外路泪囊鼻腔吻合术。两组患者术后均定期泪道冲洗，术后随访3～6个月，比较两组的治愈率、面部瘢痕情况、患者满意度、抗生素使用时间。结果48眼患者均顺利完成手术。观察组中，20眼（71.43%）完全治愈，5眼（17.86%）病情好转，3眼（10.71%）治疗无效，总体有效率为89.29%；而对照组20眼中，8眼（40.00%）完全治愈，4眼（20.00%）症状好转，8眼（40.00%）治疗无效，总体有效率为60.00%，观察组治疗效果明显优于对照组，差异有统计学意义（χ2= 5.664，P＜0.05）。观察组中，28眼均未出现明显面部瘢痕，而对照组中5眼（25.00%）出现明显面部瘢痕（χ2=7.814，P＜0.01）。观察组中，2眼（7.14%）术后患者不满意，而对照组为8眼（40.00%），差异有统计学意义（χ2=7.637，P＜0.01）。观察组抗生素使用时间为（6.9±1.1）d，明显低于对照组（14.1±4.3）d（P＜0.01）。结论人工鼻泪道管植入能有效治疗急性泪囊炎，其效果优于外路泪囊鼻腔吻合术。

急性泪囊炎；人工鼻泪管；泪囊鼻腔吻合术；抗生素

［Abstract］Objective To investigate the c1inica1 resu1ts of artificia1 naso1acrima1duct imp1antation in the treatment of acute dacryocystitis.Methods A tota1 of 48 acute dacryocystitis eyes were diagnosed and treated in our hospita1 from Apri1 2012 to August 2014.A11 patients were random1y divided into two groups:observation group（28 eyes）and contro1 group（20 eyes）.In observation group，patients received cana1icu1ar probing drainage，were imp1anted successfu11y with artificia1 naso1acrima1duct，systemic and 1oca1 administration of conventiona1 anti-infective therapy were received preoperative and postoperative；whi1e patients in contro1 group were received skin incision and drainage，underwent the traditiona1 off-road dacryocystorhinostomy after anti-infection.A11 cases were received anti-inf1ammatory therapy and 1acrima1 cana1icu1i aspirated pus necessari1y in the fo11ow-up visit for 3-6 months.Effective rate，the scar，satisfaction rate，the duration of antibiotic using were compared and ana1yzed in two groups.Results A11 subjects were received operations successfu11y.The study showed that 20 eyes（71.43%）were cured comp1ete1y，5 eyes（17.86%）got better after surgery，and obvious1y 3 eyes（10.71%）had no therapeutic effects in observation group，the tota1 effective rate was 89.29%.In contro1 group，8 eyes（40.00%）were cured comp1ete1y，4 eyes（20.00%）got better after surgery，and obvious1y 8 eyes（40.00%）had no therapeutic effects，the tota1 effective rate was 60.00%，the tota1 effective rate in observation was significant1y higher than that of contro1 group（χ2=5.664，P＜0.05）.The 28 eyes of observation group had no discovery scar，and there was 5 eyes with obvious facia1 scar in contro1 group（χ2=7.814，P＜0.01）.There were 2 eyes（7.14%）dissatisfaction in observation group and 8 eyes（40.00%）in contro1 group（χ2=7.637，P＜0.01）.In addition，the duration of antibiotic using in observation group was（6.9±1.1）d，was significant shorter than（14.1±4.3）d in contro1 group（P＜0.01）. Conclsion Artificia1 naso1acrima1duct imp1antation is c1ear1y effective than traditiona1 dacryocystorhinostomy therapy and can be a good a1ternative in treating acute dacryocystitis.

［Key words］Acute dacryocystitis；Artificia1 naso1acrima1duct；Dacryocystorhinostomy；Antibiotic

急性泪囊炎是眼科常见疾病，多由慢性泪囊炎继发，泪囊慢性炎症的急性发作，导致泪小管水肿、狭窄甚至阻塞，泪囊内液体潴留，囊腔内压力升高，进一步导致周围组织水肿、蜂窝织炎，甚至造成脓肿穿破皮肤面形成泪囊瘘管。……