[泪道探通术治疗儿童先天性鼻泪管阻塞的疗效影响因素]

Yu Gang, Hu Man, Wu Qian, Cao Wen-hong, Fan Yun-wei, Lin Qi, Liu Wen

National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.

Zhonghua Yan Ke Za Zhi. 2012 May;48(5):423-7.

OBJECTIVE

To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction (CNLDO) after failed probing and to analyze the effect of various factors that affected the recovery rate.

METHODS

Retrospective noncomparative case series. The outcome of 616 cases (eyes) of silicone intubation with the Ritleng lacrimal intubation system, performed between Feb. 2008 and Oct. 2009 on 546 children with CNLDO (aged from 3 to 156 months with an average at 11 months) from Beijing Children's Hospital, was retrospectively reviewed. The follow-up period varied from 4 to 17 months (average 11 months). The effects of age, treatment history, and the type of obstruction on the recovery rate were evaluated and the complications such as epistaxis, lacrimal duct edema or silicone tube prolapse were recorded. The statistics analysis included Pearson correlation coefficient and independent-samples t-test.

RESULTS

The overall recovery rate was 88% (544/616 cases). In the five sub-groups based on the age, 6 - 12 month, 12 - 24 month, 24 - 36 month, 36 - 48 month and older than 48 month age, the recovery rate was 96% (94/98); 94% (244/260); 87% (104/119); 77% (58/75) and 69% (44/64), respectively (R = -0.98, P = 0.003). According to the times of previous probing, there were three groups, once, twice, and more than twice, the recovery rate was 95% (291/304); 89% (163/184) and 70% (90/128), respectively (R = -0.99, P = 0.050). In the simple membranous obstruction group and the complex obstruction group, the recovery rate was 92% (343/374) and 83% (201/242), respectively (P = 0.000). Complications included laceration of lachrymal point (8 eyes, 1%) and false passage formation (14 eyes, 2%). The silicone tube prolapsed in 18 eyes (3%).

CONCLUSIONS

The Ritleng lacrimal intubation system is an easy, effective and non-traumatic procedure for the treatment of CNLDO children after failed probing. Age of the patients, times of previous probing and type of obstruction influence the recovery rate.

目的

评估Ritleng泪道插管系统在探通术失败后治疗先天性鼻泪管阻塞（CNLDO）的疗效，并分析影响治愈率的各种因素。

方法

回顾性非对照病例系列研究。对2008年2月至2009年10月在北京儿童医院对546例CNLDO患儿（年龄3至156个月，平均11个月）进行的616例（眼）使用Ritleng泪道插管系统行硅胶管插管术的结果进行回顾性分析。随访时间为4至17个月（平均11个月）。评估年龄、治疗史及阻塞类型对治愈率的影响，并记录鼻出血、泪道水肿或硅胶管脱出等并发症。统计学分析包括Pearson相关系数和独立样本t检验。

结果

总体治愈率为88%（544/616例）。在按年龄划分的五个亚组中，即6至12个月、12至24个月、24至36个月、36至48个月及48个月以上年龄组，治愈率分别为96%（94/98）、94%（244/260）、87%（104/119）、77%（58/75）和69%（44/64）（R = -0.98，P = 0.003）。根据既往探通次数分为三组，即1次、2次及2次以上，治愈率分别为95%（291/304）、89%（163/184）和70%（90/128）（R = -0.99，P = 0.050）。单纯膜性阻塞组和复杂性阻塞组的治愈率分别为92%（343/374）和83%（201/242）（P = 0.000）。并发症包括泪点撕裂8眼（1%）和假道形成14眼（2%）。硅胶管脱出18眼（3%）。