作者：刘夫玲，李虹，曾艳平，王倩，林钰 作者单位：266071）中国山东省青岛市，山东省眼科研究所 青岛眼科医院
【摘要】 目的：比较泪道激光术后药物灌注与留置泪道引流管两种方法治疗阻塞性泪道疾病的临床效果。
【关键词】 YAG激光；泪道阻塞；泪道插管
Comparison of the curative effect between lacrimal drainage tube implantation and disemboguing drug after laser deoppilation for the treatment of lacrimal ducts obstruction FuLing Liu, Hong Li, YanPing Zeng, Qian Wang, Yu Lin Department of Ophthalmology, Qingdao Eye Hospital; Shandong Eye Institute, Qingdao 266071, Shandong Province, China Abstract
AIM: To compare and evaluate the clinical effects of combination of lacrimal drainage tube implantation and disemboguing drug after laser deoppilation for patients with obstruction of lacrimal ducts。
METHODS: Eightythree patients (89 eyes ) were divided into 2 groups randomly. 38 patients ( 40 eyes ) in group A were treated with combination of Nd: YAG laser and indwelling lacrimal drainage tube. Tube was kept in place for 3 months after laser deoppilation;other 45 patients (49 eyes) in group B were treated with disembogued TobraDex after laser deoppilation. All the patients after operation were followed up for 36 months, and ultimate results were compared and analyzed.
RESULTS: Symptoms was completely resolved in 33 eyes ( 82.5%) and improved in 4 eyes (10.0%), and the total efficiency was 92.5% in group A.Symptoms was completely resolved in 21 eyes (42.9%) and improved in 13 eyes (26.5%), the total efficiency was 69.4% in group B.There were significant diferences between the two groups (P<0.05).
CONCLUSION: Laser deoppilation seems to be effective and convenient in lacrimal ducts obstruction treatment, which combined with lacrimal drainage tube implantation would obtain a better effect to treat the obstruction of lacrimal ducts.
KEYWORDS: laser; obstruction of lacrimal ducts；intubation of lacrimal passage
方法：将Nd:YAG激光疏通泪道, A组38例40眼，激光疏通泪道后联合新型泪道引流管留置3mo。 B组45例49眼，激光疏通泪道后注入典必殊药膏。术后随访3～6mo,对比分析两组的治疗效果。
结果：泪道激光疏通术后留置泪道引流管与药物灌注, 两种方法均有明显效果。治愈33眼,治愈率82.5%,好转4眼,好转率10.0% ,总有效率92.5%；B组:治愈21眼,治愈率42.9%，好转13眼,好转率26.5%,总有效率69.4%。经统计学分析两组间差异有显著性意义(χ2= 7.291，P<0.05)。
结论：泪道激光治疗泪道阻塞性疾病安全有效,联合留置新型泪道引流管治疗泪道阻塞方法疗效明显提高。
0引言 泪道阻塞是眼科的一种常见病,包括上、下泪小管阻塞,泪总管阻塞,鼻泪管阻塞。泪道阻塞使泪囊内容物储留,宜于细菌滋生,重者引起急、慢性化脓性泪囊炎、角膜溃疡,甚至威胁眼球。该病治疗方法较多,但都存在着不同程度的弊端,过去的挂线,探通等方法简便,但效果差。外科手术治疗提高了疗效,但操作复杂,并且颜面部又残留疤痕等,而且泪小管、泪总管阻塞手术相当困难[1]。我院近年开展泪道激光成形治疗泪道阻塞并加以改进，术后留置新型泪道引流管或注入典必殊药膏,比较两法的临床效果, 现总结如下。
1对象和方法 1.1对象 200706/200806我院收治的泪道阻塞患者83例89眼，上泪道阻塞(包括上、下泪小管及泪总管阻塞)27例31眼，单纯鼻泪管阻塞40例41眼；泪道阻塞继发慢性泪囊炎16例17眼。年龄30～71（平均47.7）岁。病程3mo～15a，平均3.5a。将患者随机分为A，B 两组:A 组38例40眼，激光成形植入新型泪道引流管3mo；B组45例49眼，激光疏通泪道后注入典必殊药膏。
图1 带双头探针的泪道引流管和泪道引流钩（略）
图2 上下泪小点处暴露泪道引流管的硅胶管部分（黑箭头）（略）
1.2方法
1.2.1手术器材 采用武汉兴华光电工程有限公司Nd:YAG20型多功能脉冲泪道激光治疗机,激光波长1.06μm,工作频率0～20Hz,输出能量480mJ,光纤直径0.4mm。特制泪道探针9 号(带针芯)；山东福瑞达医疗器械有限公司出品的Fr2 新型泪道引流管(带双头探针的硅胶管),配备手术专用的泪道引流钩（图1）。泪道冲洗针头(6～7号)、泪小点扩张器等用品。
1.2.2手术方法 两组患者均常规泪道激光治疗，激光点射疏通泪道后，抽出激光纤维，拔出探针后泪道注入抗生素，如患者感鼻咽部有水则表明激光疏通成功。A组患者激光疏通后还需要留置新型泪道引流管，具体方法如下：用双头探针的两头分别自上下泪点插入泪道至下鼻甲,前鼻镜下用泪道引流钩分别取出两个探针头端拉至鼻外并将硅胶管拉入泪道。此时硅胶管贯穿全泪道,上下泪小点处仅留5mm 环管暴露（图2）,去掉硅胶管前端探针,调整硅胶管长度,多余部分剪去,将两端硅胶管结扎,固定于鼻腔内。B组患者泪道激光疏通阻塞部位后将加热的典必殊眼膏约0.5～1.0mL，泪道内边推药边退针,使其阻塞部位被药物填充。
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