Movaghar M, Kodsi S, Merola C, Doyle J
Department of Ophthalmology and the Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
J AAPOS. 2000 Jun;4(3):179-82.
Nasolacrimal duct obstruction occurs in 5% to 6% of neonates. Many studies advocate the probing of nasolacrimal duct obstruction under general inhalational anesthesia in patients at a late age (12 to 13 months) because a high percentage will resolve spontaneously. Others support early surgical intervention in patients aged younger than 6 to 9 months without anesthesia. We present late nasolacrimal duct probing under intravenous propofol sedation as an alternative approach to the treatment of nasolacrimal duct obstruction with a decrease in cost and time compared with probing under general inhalational anesthesia.
We made a retrospective review of patient charts of children who underwent nasolacrimal duct probing with intravenous propofol sedation from April 1996 to September 1997. Procedure time and cost of procedure were compared for patients who had probings under propofol sedation to patients who had probings under general anesthesia.
A total of 22 patients (31 eyes) underwent nasolacrimal duct probing with propofol sedation; the patients' ages ranged from 11.5 to 39 months (average age, 17.8 months). Twenty-six (84%) of 31 eyes had resolution of the symptoms. The average total time for procedure under propofol sedation was 10.5 minutes, compared with 43.6 minutes under general inhalational anesthesia. The average total recovery time under propofol sedation was 13.6 minutes, compared with 121.1 minutes with general inhalational anesthesia. The cost of probing under propofol sedation was one third less than the cost of probing under general inhalational anesthesia.
Late probing for nasolacrimal duct obstruction under intravenous propofol sedation is comparable in efficacy to late probing under general inhalational anesthesia with a shorter time for the procedure and decreased expense.
5%至6%的新生儿会出现鼻泪管阻塞。许多研究主张，对于大龄患者（12至13个月），在全身吸入麻醉下对鼻泪管阻塞进行探查，因为很大一部分会自行缓解。另一些人则支持对6至9个月以下的患者在无麻醉的情况下进行早期手术干预。我们介绍了在静脉注射丙泊酚镇静下进行晚期鼻泪管探查，作为治疗鼻泪管阻塞的一种替代方法，与全身吸入麻醉下的探查相比，成本和时间有所降低。
我们对1996年4月至1997年9月期间接受静脉注射丙泊酚镇静下鼻泪管探查的儿童患者病历进行了回顾性研究。将丙泊酚镇静下探查的患者与全身麻醉下探查的患者的手术时间和手术费用进行了比较。
共有22例患者（31只眼）接受了丙泊酚镇静下的鼻泪管探查；患者年龄在11.5至39个月之间（平均年龄17.8个月）。31只眼中有26只（84%）症状得到缓解。丙泊酚镇静下手术的平均总时间为10.5分钟，而全身吸入麻醉下为43.6分钟。丙泊酚镇静下的平均总恢复时间为13.6分钟，而全身吸入麻醉下为121.1分钟。丙泊酚镇静下探查的费用比全身吸入麻醉下探查的费用少三分之一。
静脉注射丙泊酚镇静下对鼻泪管阻塞进行晚期探查，在疗效上与全身吸入麻醉下的晚期探查相当，手术时间更短，费用更低。
