Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Jpn J Ophthalmol. 2010 Jan;54(1):24-31. doi: 10.1007/s10384-009-0755-7. Epub 2010 Feb 12.
To analyze the outcomes (success, failure) and complications of surgical repair of canalicular lacerations by bicanalicular nasal intubation in a series of patients treated over a 7-year period.
The case records of 98 patients undergoing surgical repair of canalicular lacerations were retrospectively reviewed. Patient characteristics and results of the surgical repair were analyzed to identify factors that may influence the outcomes. Two groups (success and failure) were statistically compared with the Mann-Whitney U test for scale variables and with Fisher's exact test for categorical variables.
Of the 98 patients, 78 (79.6%) had patency after irrigation (anatomic success) and 83 (84.7%) were asymptomatic (functional success). Patients age, sex, injury location, anesthetic methods, and timing of surgical repair were not significantly associated with the postoperative patency of the lacerated canaliculus. Having a stent left for more than 90 days was significantly associated with restoration of the canalicular anatomy (P < 0.01). Patients with postoperative anatomic patency had a significantly lower rate of symptomatic epiphora than patients with anatomic obstruction (P < 0.001). Symptomatic epiphora was significantly more frequent in patients with combined upper and lower canalicular injuries (P < 0.01).
Our results suggest that retaining bicanalicular silicone nasal intubation for more than 90 days can provide satisfactory results in restoring both canalicular anatomy and function. With an experienced operating team, repair of canalicular lacerations can be delayed for up to 11 days. However, patients with combined upper and lower canalicular lacerations are at an increased risk of developing postoperative symptomatic epiphora.
分析在 7 年的时间里对一系列接受治疗的患者进行鼻内双泪小管插管的泪小管断裂修复手术的结局（成功、失败）和并发症。
回顾性分析 98 例行泪小管断裂修复手术的患者的病历。分析患者特征和手术修复结果，以确定可能影响结果的因素。对两组（成功组和失败组）进行统计学比较，采用 Mann-Whitney U 检验进行尺度变量比较，采用 Fisher 确切检验进行分类变量比较。
98 例患者中，78 例（79.6%）在冲洗后通畅（解剖学成功），83 例（84.7%）无症状（功能成功）。患者年龄、性别、损伤部位、麻醉方法和手术修复时间与断裂泪小管的术后通畅率无显著相关性。支架留置时间超过 90 天与重建泪小管解剖结构显著相关（P<0.01）。术后解剖通畅的患者出现症状性溢泪的发生率明显低于解剖阻塞的患者（P<0.001）。同时存在上、下泪小管损伤的患者出现症状性溢泪的频率明显更高（P<0.01）。
我们的结果表明，留置双泪小管硅胶鼻内插管超过 90 天可提供令人满意的结果，同时恢复泪小管解剖结构和功能。在有经验的手术团队的操作下，泪小管断裂的修复可延迟至 11 天。然而，同时存在上、下泪小管损伤的患者发生术后症状性溢泪的风险增加。
