陈旧性泪小管断裂修复术：疗效及预后因素的回顾性研究
Old canalicular laceration repair: a retrospective study of the curative effects and prognostic factors.
作者信息
Bai Fang, Tao Hai, Zhang Yan, Wang Peng, Han Cui, Huang Yi-Fei, Tao Ye
机构信息
Department of Ophthalmology, General Hospital of Chinese PLA, Beijing 100853, China.
The Lacrimal Center of Ophthalmology, Armed Police General Hospital of China, Beijing 100039, China.
出版信息
Int J Ophthalmol. 2017 Jun 18;10(6):902-907. doi: 10.18240/ijo.2017.06.11. eCollection 2017.
AIM
To investigate the epidemiology and surgical outcomes of old canalicular laceration and analyze the variables impacting on the prognosis of reparation.
METHODS
A retrospective review of all old canalicular laceration repairs from Jan. 1, 2008 to Dec. 30, 2015 was performed. Analyzed data included demographics, mechanisms of injury, the time from injury to repair, causes for delayed repair, old associated injuries, the types of surgery, and the effects of repair using canaliculus anastomosis combined with bicanalicular stent intubation.
RESULTS
Totally 148 patients with old canalicular laceration received surgical repair and were enrolled. The mean age at presentation was 32.52 years old (ranged from 3 to 63 years old). The 110 patients (74.32%) were male and 127 patients (85.81%) were adults (≥18 years old). The old upper, lower, and bicanalicular lacerations were found in 5 (3.38%), 39 (26.35%), and 104 patients (70.27%), respectively. The mechanism of old injury was primarily due to motor vehicle accidents (=53, 35.81%). The mean time from injury to repair was 43.61mo (ranged from 1 to 360mo). Associated old ocular and orbit injuries were found in 65 patients (43.92%), and chronic dacryocystitis in 18 patients (12.16%). The main cause of delayed repair was that doctors or patients didn't pay attention to the canalicular laceration because of the concurrent severe injuries (=71, 47.97%). Totally 136 patients (91.89%) with old canalicular laceration underwent canaliculus anastomosis combined with bicanalicular stent intubation. In all of them, 20 patients (13.51%) were combined with dacryocystorhinostomy. In these cases, 132 patients (97.06%) attained anatomic success, 121 patients (88.97%) reported no epiphora (functional success), 11 patients (8.09%) reported significant epiphora anesis (functional improvement), and 4 (2.94%) reported no significant anesis (functional failure). Rates of anatomic success and functional success were significantly correlated with different canaliculus involved. However, rates of anatomic success and functional success were not significantly affected by the time from injury to repair.
CONCLUSION
The canalicular anastomosis combined with bicanalicular stent intubation could act as an effective therapeutics for old canalicular laceration.
目的
探讨陈旧性泪小管断裂的流行病学特征及手术疗效，并分析影响修复预后的相关因素。
方法
回顾性分析2008年1月1日至2015年12月30日期间所有陈旧性泪小管断裂修复病例。分析的数据包括人口统计学资料、损伤机制、受伤至修复的时间、延迟修复的原因、陈旧性合并伤、手术方式以及泪小管吻合联合双泪小管支架植入术的修复效果。
结果
共纳入148例接受手术修复的陈旧性泪小管断裂患者。患者就诊时的平均年龄为32.52岁（3至63岁）。其中男性110例（74.32%），成年人127例（85.81%）（≥18岁）。单纯上泪小管陈旧性断裂5例（3.38%），下泪小管陈旧性断裂39例（26.35%），双泪小管陈旧性断裂104例（70.27%）。陈旧性损伤的主要机制为机动车事故（53例，35.81%）。受伤至修复的平均时间为43.61个月（1至360个月）。65例（43.92%）患者合并有陈旧性眼及眼眶损伤，18例（12.16%）合并慢性泪囊炎。延迟修复的主要原因是合并严重损伤时医生或患者未重视泪小管断裂（71例，47.97%）。136例（91.89%）陈旧性泪小管断裂患者接受了泪小管吻合联合双泪小管支架植入术。其中20例（13.51%）合并泪囊鼻腔吻合术。在这些病例中，132例（97.06%）获得解剖学成功，121例（88.97%）无溢泪（功能成功），11例（8.09%）溢泪明显减轻（功能改善），4例（2.94%）溢泪无明显改善（功能失败）。解剖学成功率和功能成功率与不同受累泪小管显著相关。然而，受伤至修复的时间对解剖学成功率和功能成功率无显著影响。
结论
泪小管吻合联合双泪小管支架植入术是治疗陈旧性泪小管断裂的有效方法。
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