Dzhambazov Karen B, Gyulev Ivan A, Traikova Nikoleta I, Yovchev Ilia P
Department of Ear, Nose and Throat Diseases, Medical University, Plovdiv, 15A Vassil Aprilov St., 4002 Plovdiv, Bulgaria.
Folia Med (Plovdiv). 2005;47(3-4):28-32.
Congenital stenosis of nasolacrimal duct is a common medical problem affecting up to 20% of newborn infants. When symptoms persists for more than 5 to 6 months the lacrimal ducts should be subjected to probing and irrigation. Anterograde probing through inferior lacrimal punctum using a rigid Bowman probe is the standard approach to such cases. We could not find reports of a retrograde endonasal probing of the lacrimal ducts in the available literature published in the last five years.
Between 1992 and 2002, we treated 328 children (136 boys and 192 girls) with congenital stenoses of the lacrimal passageways. The mean age of the children was 7.4 (Sx +/- 13) months. Endonasal probing and retrograde irrigation of lacrimal ducts were performed in all children, taking into consideration the individual peculiarities of the obstruction and the anatomical accessibility of the opening of ductus nasolacrimalis in the inferior nasal passageway.
Outflow of irrigation fluid from lacrimal puncta was observed at the first probing in 90% out of a total number of 401 primary probings. Because of persistent membranes in the inferior lacrimal punctum in 3 cases (0.8%) we had to repeat the initial dilatation. The repeated probing failed to ensure reliable establishment of lacrimal duct patency only in 1% of the cases. In such children we recommended and performed endonasal dacryocystorhinostomy with balloon intubations placing a catheter and this restored lacrimal drainage to the nasal cavity.
Endonasal probing and irrigation of lacrimal ducts used in the treatment of congenital stenoses is a highly effective (99%), physiologically consistent and little traumatic method of reestablishing the patency of the tear draining system. If it fails, endonasal dacryocystorhinostomy with stents is the definitive treatment of children's dacryocystitis.
先天性鼻泪管狭窄是一个常见的医学问题，影响多达20%的新生儿。当症状持续超过5至6个月时，应进行泪道探查和冲洗。使用硬质鲍曼探针经下泪点进行顺行探查是此类病例的标准方法。在过去五年发表的现有文献中，我们未找到鼻泪管逆行鼻内探查的报告。
1992年至2002年期间，我们治疗了328例泪道先天性狭窄的儿童（136名男孩和192名女孩）。儿童的平均年龄为7.4（标准差±13）个月。考虑到梗阻的个体特点以及鼻泪管在下鼻道开口的解剖可达性，对所有儿童进行了鼻泪管的鼻内探查和逆行冲洗。
在401次初次探查中，90%的病例在首次探查时观察到冲洗液从泪点流出。由于3例（0.8%）下泪点存在持续的膜，我们不得不重复初始扩张。仅1%的病例中，重复探查未能确保可靠地建立泪道通畅。对于此类儿童，我们建议并进行了带气囊插管的鼻内泪囊鼻腔造口术并放置导管，这恢复了泪液向鼻腔的引流。
用于治疗先天性狭窄的鼻泪管鼻内探查和冲洗是一种高效（99%）、生理上一致且创伤小的重建泪液引流系统通畅的方法。如果失败，带支架的鼻内泪囊鼻腔造口术是儿童泪囊炎的最终治疗方法。
