He J J, Gong J W, Jiang J
Department of Ophthalmology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou310004, China.
Zhonghua Yan Ke Za Zhi. 2024 Dec 11;60(12):998-1003. doi: 10.3760/cma.j.cn112142-20240511-00219.
To investigate the clinical efficacy of wound exclusion combined with silicone tube bicanalicular intubation for treatment of pigmented nevi of the lacrimal punctum. A retrospective case series analysis was conducted. Clinical data were collected from patients with pigmented nevi of the lacrimal punctum who underwent wound exclusion combined with silicone tube bicanalicular intubation at the Ophthalmology Center of Zhejiang Provincial People's Hospital from April 2020 to February 2023. During the surgery, a linear silicone tube was annularly placed to support the punctum and lacrimal canaliculus under local anesthesia, followed by the pigmented nevus excision under a surgical microscope. The linear silicone tube was removed at 4 to 6 weeks postoperatively. The duration of surgery and postoperative recovery status were recorded and summarized, including the recurrence of the pigmented nevus, epiphora, shape and position of the punctum, medial canthal morphology, and local scar condition. This study included a total of 15 patients, 5 males and 10 females, with an average age of (47.7±13.5) years (range, 19 to 65 years). Two patients had pigmented nevi of the upper punctum, and 13 had pigmented nevi of the lower punctum. All nevi grew around the punctum and were completely excised during the surgery, which lasted (21.8±2.4) minutes on average. By 2 weeks postoperatively, all wounds healed with conjunctivalization, and new punctum openings formed. By 4 to 6 weeks postoperatively, the eyelid margin morphology was almost normal, when the linear silicone tube was removed. The follow-up ranged from 6 months to 2 years. No recurrence of the pigmented nevus was observed during the follow-up. The puncta were well formed without the symptom of epiphora, the medial canthal morphology was basically symmetrical to the healthy side, and the eyelid margin scars were inconspicuous, with a satisfactory appearance. No complications such as punctal occlusion, trichiasis, entropion, and ectropion occurred. For exophytic pigmented nevi of the punctum that do not deeply involve the lacrimal canaliculus, using the wound exclusion combined with silicone tube bicanalicular intubation during the nevus excision may reduce surgical trauma. This simple and feasible method can achieve good therapeutic effects and cosmetic outcomes.
探讨伤口封闭联合硅胶管双泪小管插管治疗泪小点色素痣的临床疗效。进行回顾性病例系列分析。收集2020年4月至2023年2月在浙江省人民医院眼科中心接受伤口封闭联合硅胶管双泪小管插管治疗的泪小点色素痣患者的临床资料。手术中，在局部麻醉下环形放置线性硅胶管以支撑泪小点和泪小管，随后在手术显微镜下切除色素痣。术后4至6周取出线性硅胶管。记录并总结手术时间和术后恢复情况，包括色素痣复发、溢泪、泪小点形状和位置、内眦形态及局部瘢痕情况。本研究共纳入15例患者，其中男性5例，女性10例，平均年龄为（47.7±13.5）岁（范围19至65岁）。2例患者为上泪小点色素痣，13例为下泪小点色素痣。所有痣均生长在泪小点周围，手术中均被完整切除，平均手术时间为（21.8±2.4）分钟。术后2周时，所有伤口均结膜化愈合，形成新的泪小点开口。术后4至6周，取出线性硅胶管时，眼睑边缘形态基本正常。随访时间为6个月至2年。随访期间未观察到色素痣复发。泪小点形成良好，无溢泪症状，内眦形态与健侧基本对称，眼睑边缘瘢痕不明显，外观满意。未发生泪小点阻塞、倒睫、睑内翻和睑外翻等并发症。对于未深度累及泪小管的外生性泪小点色素痣，在切除痣时采用伤口封闭联合硅胶管双泪小管插管可减少手术创伤。这种简单可行的方法可取得良好的治疗效果和美容效果。
