Kersten R C, Kulwin D R
Department of Opthalmology University of Cincinnati College of Medicine, Ohio, USA.
Ophthalmology. 1996 May;103(5):785-9. doi: 10.1016/s0161-6420(96)30615-5.
It has been widely believed that direct microsurgical re-anastomosis of the canalicular epithelium is necessary for satisfactory repair of canalicular lacerations. However, because repair is carried out in conjunction with placement of an indwelling silicone stent, this stent should keep the canalicular edges adequately approximate without the need for suturing. The authors report their results in repairing canalicular lacerations using a single, fine, horizontal, mattress suture to re-approximate the overlying pericanalicular orbicularis muscle and eliminate direct microsurgical re-anastomosis of the canalicular epithelium.
The authors retrospectively reviewed the charts of 67 patients who underwent repair of lacerated canaliculi with one-stitch re-approximation of the overlying orbicularis muscle in conjunction with bicanalicular silicone tube intubation. Stents were left in place for 3 months postoperatively and then removed. Probing across the lacerated portion of the canaliculus was carried out at the time of stent removal to ensure patency. Dye disappearance testing with 2% fluorescein and irrigation through the canaliculus then was performed 6 weeks to 3 months after stent removal.
Of the 67 patients, 59 were followed to stent removal. Probing with a 00 probe showed canalicular patency in all 59 patients. Irrigation resulted in reflux in two patients, indicating unrelated nasolacrimal duct obstruction. Of these 59 patients, 45 complied with scheduled follow-up 6 weeks to 3 months after stent removal. Dye disappearance testing using 2% fluorescein demonstrated delay in lacrimal outflow in 6 of the 45 patients. Only two patients had symptomatic epiphora, and in both patients there was an underlying nasolacrimal duct obstruction confirmed by irrigation.
Simple re-approximation of the lacerated overlying soft tissue combined with bicanalicular silicone intubation proved highly successful in managing canalicular lacerations. Probing through the lacerated canaliculus demonstrated patency in 100% of the 59 patients followed to stent removal. Only 4% of patients had symptomatic epiphora postoperatively, and 13% demonstrated some delay in outflow with dye disappearance testing. This compares very favorably with previous reported series in which lacerated canaliculi were microsurgically re-anastomosed.
人们普遍认为，为使泪小管撕裂伤得到满意修复，直接进行泪小管上皮的显微外科再吻合术是必要的。然而，由于修复是在留置硅胶支架的同时进行的，该支架应能使泪小管边缘充分贴合，而无需缝合。作者报告了他们使用单根精细水平褥式缝线修复泪小管撕裂伤的结果，该方法用于重新贴合覆盖其上的泪小管周围眼轮匝肌，避免直接进行泪小管上皮的显微外科再吻合术。
作者回顾性分析了67例泪小管撕裂伤患者的病历，这些患者接受了覆盖其上的眼轮匝肌单针重新贴合术并联合双泪小管硅胶管插管术。术后支架留置3个月，然后取出。取出支架时对泪小管撕裂部位进行探查以确保通畅。取出支架6周后至3个月内，使用2%荧光素进行染料消失试验，并通过泪小管进行冲洗。
67例患者中，59例随访至支架取出。用00探针探查显示所有59例患者泪小管通畅。冲洗导致2例患者出现反流，提示存在无关的鼻泪管阻塞。在这59例患者中，45例在支架取出后6周内至3个月内按计划进行了随访。使用2%荧光素进行的染料消失试验显示，45例患者中有6例泪液流出延迟。只有2例患者有症状性溢泪，且通过冲洗证实这2例患者均存在潜在的鼻泪管阻塞。
撕裂伤覆盖的软组织简单重新贴合联合双泪小管硅胶插管术在处理泪小管撕裂伤方面被证明非常成功。对59例随访至支架取出的患者进行的泪小管撕裂部位探查显示，100%通畅。术后只有4%的患者有症状性溢泪，13%的患者在染料消失试验中显示流出存在一定延迟。这与先前报道的对泪小管撕裂伤进行显微外科再吻合术的系列研究结果相比非常有利。
