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止损琼斯管的手术效果及并发症处理:一项单中心研究

Surgical outcomes and management of complications of StopLoss Jones tube: a single-center study.

作者信息

Sonmez Hatice Kubra, Unlu Metin

机构信息

Department of Ophthalmology, Division of Oculoplastic and Lacrimal Surgery Unit, Erciyes University Medical Faculty, Kayseri, Türkiye.

出版信息

Int Ophthalmol. 2024 Dec 11;45(1):7. doi: 10.1007/s10792-024-03380-7.

DOI:10.1007/s10792-024-03380-7
PMID:39661204
Abstract

PURPOSE

We evaluated the surgical outcomes and management of complications associated with the minimally invasive conjunctivodacryocystorhinostomy using the StopLoss Jones (SLJT) tube of proximal lacrimal canal obstruction.

METHODS

The study retrospectively included 22 eyes of 15 patients who underwent SLJT for proximal canalicular obstruction. Age, gender, follow-up duration, etiology of canalicular obstruction, previous surgery, tube size, complications, and the need for additional surgical intervention were assessed. Standard tube placement was performed with intranasal endoscopic visualization.

RESULTS

The mean age (± standard deviation) of the 15 patients included in the study was 59.5 ± 8.34 years. The most common etiology was idiopathic (86.4%), and 45.5% of the 22 eyes had no prior surgery. The median follow-up duration was 12.5 months, 27% of the eyes had a follow-up duration of more than 2 years. The mean time to postoperative complication development was 4.88 ± 3.29 months. Complications were observed in 8 eyes: 4 had conjunctivalization with inferior migration, 1 had only inferior migration, 2 had conchal obstruction (one of which had a nasal mucosal plug), 1 had tube fracture, and 1 eye developed a conjunctival ulcer due to suture irritation. No extrusion was observed.

CONCLUSION

SLJT is an effective method for proximal obstructions due to its minimally invasive nature, low rate of tube loss, functionality, and comfort for both patients and surgeons. Although complications are more frequently observed in the early postoperative period and vary depending on the endoscopic approach, tube angle, and regional anatomy, we believe that they can be corrected with early intervention without tube extrusion.

摘要

目的

我们评估了使用StopLoss Jones(SLJT)管治疗近端泪小管阻塞的微创结膜泪囊鼻腔吻合术的手术效果及并发症处理。

方法

本研究回顾性纳入了15例因近端泪小管阻塞接受SLJT治疗的患者的22只眼。评估了年龄、性别、随访时间、泪小管阻塞病因、既往手术史、置管型号、并发症以及是否需要额外手术干预。通过鼻内镜直视下进行标准置管。

结果

纳入研究的15例患者的平均年龄(±标准差)为59.5±8.34岁。最常见的病因是特发性(86.4%),22只眼中45.5%既往未行手术。中位随访时间为12.5个月,27%的患眼随访时间超过2年。术后并发症发生的平均时间为4.88±3.29个月。8只眼出现并发症:4只眼发生结膜化伴下移,1只眼仅出现下移,2只眼发生鼻甲阻塞(其中1只眼有鼻黏膜堵塞),1只眼发生置管断裂,1只眼因缝线刺激出现结膜溃疡。未观察到置管脱出。

结论

SLJT因其微创性、低脱管率、功能性以及对患者和术者的舒适性,是治疗近端阻塞的有效方法。尽管并发症在术后早期更常见,且因内镜入路、置管角度和局部解剖结构而异,但我们认为早期干预可纠正这些并发症,且不会发生置管脱出。

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本文引用的文献

1
Long-term outcomes of StopLoss™ Jones tube (SLJT) and minimally invasive conjunctivodacryocystorhinostomy.StopLoss™ Jones 管(SLJT)和微创经结膜鼻腔泪囊吻合术的长期疗效。
Graefes Arch Clin Exp Ophthalmol. 2022 Jan;260(1):327-333. doi: 10.1007/s00417-021-05347-1. Epub 2021 Aug 12.
2
Long-Term Quality of Life in Patients Following Minimally Invasive Conjunctivodacryocystorhinostomy With StopLoss Jones Tube.采用防逆流琼斯管的微创结膜泪囊鼻腔吻合术后患者的长期生活质量
Ophthalmic Plast Reconstr Surg. 2022;38(2):170-175. doi: 10.1097/IOP.0000000000002017.
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Conjunctivodacryocystorhinostomy (CDCR) success rates and complications in endoscopic vs non-endoscopic approaches: a systematic review.
经内镜与非内镜入路行结膜囊鼻腔吻合术(CDCR)的成功率和并发症:系统评价。
Int Forum Allergy Rhinol. 2021 Feb;11(2):174-194. doi: 10.1002/alr.22668. Epub 2020 Aug 6.
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The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy With Frosted Jones Tubes.带磨砂琼斯管的结膜泪囊鼻腔造口术的有效性及长期疗效
Ophthalmic Plast Reconstr Surg. 2017 Jul/Aug;33(4):294-299. doi: 10.1097/IOP.0000000000000764.
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Early Experience with the StopLoss Jones Tube.止损琼斯导管的早期经验。
Orbit. 2015 Jun;34(3):132-6. doi: 10.3109/01676830.2015.1014507. Epub 2015 Apr 22.
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Twelve-Year Experience of Lester Jones Tubes—Results and Comparison of 3 Different Tube Types.莱斯特·琼斯管12年的使用经验——三种不同类型管子的结果及比较
Ophthalmic Plast Reconstr Surg. 2015 Sep-Oct;31(5):352-6. doi: 10.1097/IOP.0000000000000340.
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Ophthalmic Plast Reconstr Surg. 2012 Nov-Dec;28(6):393-5. doi: 10.1097/IOP.0b013e31826115fe.
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Ophthalmology. 2007 Jul;114(7):1403-8. doi: 10.1016/j.ophtha.2006.10.021. Epub 2007 Feb 6.
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A 16-year study of conjunctival dacryocystorhinostomy.一项关于结膜泪囊鼻腔吻合术的16年研究。
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