作者：徐东强，曾波
作者单位：（430070）中国湖北省武汉市，广州军区武汉总医院眼科
【摘要】目的：了解外伤性泪小管断裂位置的规律，为手术时方便寻找鼻侧断端口提供依据。
方法：外伤性泪小管断裂患者105例，18~72（平均35.6）岁，常见致伤原因依次为：车祸伤，拳击伤，手抓伤，工伤，眼镜划伤等；所有患者手术时通过直视法或逆行法找到鼻侧断裂口，用游标卡尺测量。若鼻侧断端位于下睑，则测量鼻侧断裂口与下泪点的距离，与下睑缘和最近下睑皮肤表面的距离，若鼻侧断端位于内眦部，则测量鼻侧断端与内眦点的距离和与最近内眦部皮肤表面的距离。
结果：鼻侧断端位于下睑时，与下泪点距离为（8.56±4。25）mm，与睑缘表面距离为（1.54±0.67）mm，与下睑皮肤表面最近距离为（7.36±3.71）mm；鼻侧断端位于内眦部时，与内眦点的距离（2.12±0.53）mm，与内眦部皮肤表面的最近距离（3.24±0.92）mm。
结论：根据上述解剖测量结果，泪小管断裂吻合手术中会较容易寻找到鼻侧断端。
【关键词】 泪小管断裂;解剖
Anatomical measurement of rupture position of lower canaliculus
DongQiang Xu, Bo Zeng
Department of Ophthalmology,Wuhan General Hospital of Guangzhou Military Command,Wuhan 430070,Hubei Province, China
Correspondence to: DongQiang Xu. Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, Hubei Province, China. [email protected]
AbstractAIM: To know the rules of traumatic rupture position of lower canaliculus, providing the basis of seeking nasal end during the repairing operations.METHODS: Totally, 105 cases of traumatic rupture of lower canaliculus, ranging from 18 to 72 years old (mean 35.6 years) were included in this study. The common causes were traffic accident trauma, boxing wound, claw, working trauma, laceration by glasses etc. Firstly, we orthoptically or regressively found nasal end of ruptured canaliculus in all patients, then measured by vernier calipers. If nasal ends were in the lower lids, we would measure the distance between it to lower lacrimal punctra, the distance between it to lower lid margin, the proximate distance from it to lower lid surface; If nasal ends were in the inner canthus, we would measure the distance between nasal ends to inner canthus point, the proximate distance from it to skin surface of inner canthus.RESULTS: When nasal ends were in the lower lids, the distances mentioned above were （8.56±4.25）mm, （1.54±0.67）mm, and （7.36±3.71）mm, respectively. When nasal ends were in the inner canthus, the distances were （2.12±0.53）mm and （3.24±0.92）mm.CONCLUSION: According to the results, seeking nasal ends would be easer during repairing procedures.
KEYWORDS: canaliculal rupture; anatomy
0引言
泪小管断裂是眼科常见外伤，泪小管吻合术也是常见、且比较容易掌握的急诊手术，但是在有些情况下，寻找鼻侧断端也不是一件容易的事情。根据我们的经验，对泪小管解剖位置不清晰，特别是活体外伤时断裂口的可能位置不熟悉，是手术失败或困难的主要原因。自200503/200803我院收治外伤性泪小管断裂105例，均急诊行泪小管吻合术，术中进行相关解剖测量，结果报告如下。
1对象和方法
1.1对象
外伤性下泪小管断裂患者105例，其中伴上泪小管断裂4例，右眼57例，左眼48例；年龄18～72（平均35.6）岁。致伤原因：拳击伤33例，车祸伤21例，手抓伤19例，工伤18例，眼镜划伤9例，其他原因伤5例。伤后至就诊时间在30min～20h之间，均行一期泪小管断端吻合术。测量工具为一最小刻度为0.1mm的游标卡尺。因伤情复杂，本研究排除了伴内眦韧带断裂、下睑内侧及鼻根部严重裂伤或撕脱伤、泪囊破裂、及泪骨骨折等病例。
1.2方法
以倍诺喜眼药水点眼，常规消毒处理创面，暂不行局部浸润麻醉；轻柔操作，直视法或逆行法寻找泪小管断端：见到淡粉色或淡灰白色喇叭口样边缘较光滑结构，即以冲洗针头插入其内，生理盐水冲洗，证明其确为泪小管。以通过睑裂最内侧点并与睑裂垂直的想象线为界，若鼻侧断端在该线颞侧，则认为鼻侧断端位于下睑缘内，相反则认为鼻侧断端位于内眦部。若鼻侧断端位于下睑，则测量鼻侧断裂口与下泪点的距离，与下睑缘和最近下睑皮肤表面的距离；若鼻侧断端位于内眦部，则测量与内眦点的距离和与最近内眦部皮肤表面的距离。所得数据均用平均数±标准差（±s）表示。
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