先天性鼻泪管阻塞的晚期及极晚期初次探查：失败原因是什么？
Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?
作者信息
Kashkouli M B, Beigi B, Parvaresh M M, Kassaee A, Tabatabaee Z
机构信息
Ocular Adnexal Unit, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
出版信息
Br J Ophthalmol. 2003 Sep;87(9):1151-3. doi: 10.1136/bjo.87.9.1151.
AIMS
To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children.
METHODS
In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye.
RESULTS
138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up.
CONCLUSION
Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.
目的
探讨先天性鼻泪管阻塞（CNLDO）晚期（2岁）及极晚期（3 - 5岁）首次探通术的治愈率，并确定大龄儿童探通术失败率的相关影响因素。
方法
在一项前瞻性干预性病例系列研究中，125例连续的1 - 5岁CNLDO患者的169只眼在全身麻醉下接受探通术。治愈定义为患眼无流泪和分泌物。
结果
纳入101例年龄在13 - 60个月（平均23.4（标准差10.2））患者的138只眼。15只（10.8%）复杂性CNLDO眼中，80%在24个月龄后出现（p<0.0001）。13 - 24个月龄患者的治愈率为89%，24个月龄后为72%（p = 0.01）。晚期和极晚期探通术中，膜性CNLDO的治愈率为90.2%，复杂性CNLDO为33.3%（p<0.0001）。术后1周治愈率与最终随访治愈率高度相关（r = 0.97），且无显著差异。
结论
复杂性CNLDO的累积是大龄儿童探通术失败的主要危险因素。鼻泪管探通术后1周的结果高度预示最终结局。
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