气囊导尿管与明胶海绵在泪囊手术中的应用对比
作者：邵毅 裴重刚 杨璐 周琼。
【摘要】 目的：应用气囊导尿管、明胶海绵应用于泪囊鼻腔吻合术中的临床疗效。方法：将慢性泪囊疾病患者200例(200眼)按照随机的原则分成2组：A组(气囊导尿管组)100眼，B组(明胶海绵组)100眼,观察手术后连续1mo溢泪及冲洗泪道通畅情况。结果：A组中治愈99眼(99%)；B组中治愈93眼(93%)。两组疗效及并发症，差异有显著意义(P 0.05)。结论：气囊导尿管治愈率较高，充填吻合道，对止血、防止粘连、抑制纤维化及减轻吻合口收缩起重要作用，是较为安全，有效，使用方便理想的留置物。
Aerocyst urethral catheter insertion compared to compressed gelatin sponges application in dacryocystorhinostomy。
Abstract AIM: To evaluate the clinical effect of two different filling material on treating chronic dacryocystitis：aerocyst urethral catheter, compressed gelatin sponges. METHODS: Two hundred patients(200 eyes)with chronic deacryocystis disease were divided into two groups：group A(100 eyes) accepted aerocyst urethral catheter as a filling material in EXTDCR，group B(100 eyes)accepted compressed gelatin sponges. The condition of epiphora and syringing of the lacrimal passage were observed in the first month after the operation continuous1y. RESULTS: There were 99 eyes cured (99％) in group A and 93 eyes cured(93％) in group B .There was significantly statistical difference between the two groups in the surgical success rate and the operative complications (P 0.05). CONCLUSION: It is believed that the with higher success rate in Group A，fewer operative complications and a high patient satisfaction can be used to simplify and speed up traditional EXTDCR．aerocyst urethral catheter play a important function in stopping hemorhage and preventing adhesion and inhabiting fibrous tissue growth and reducing contraction of anastomosis．Aerocyst urethral catheter is a safe, effective and ideal filling material for treatment of chronic deacryocystis disease, which can be cured or improved．。
· KEYWORDS: aerocyst urethral catheter；chronic dacryocystitis；dacryocystorhinostomy。
0引言。
慢性泪囊疾病是眼科常见的泪器病,而泪囊鼻腔吻合术是其治疗的首选方法。由于泪总管开口和骨孔处纤维组织增生，肉芽和瘢痕形成等常见原因，仍有部分病例术后失败.另外术后吻合口骨窗过小、吻合口中血凝块、吻合瓣过松及瓣缝线脱落均可引起吻合口的阻塞，导致手术失败。为了提高手术成功率，减少术后出血，使吻合口腔足够大，术后置放何种引流物于吻合腔内也就至关重要.我院2002/2005年分别采用气囊导尿管和明胶海绵两种材料治疗200例慢性泪囊疾病, 采用两样本t 检验对其基本资料、临床疗效等方面进行比较分析。现报告如下。
1对象和方法。
1.1对象 随机选择2002/2005年慢性泪囊疾病（包括泪囊炎和泪囊囊肿）住院患者共200例(200眼)。其中均为单眼。年龄13～63（平均42）岁。男90例，女110例。病程1mo～18a，平均76mo。根据在泪囊鼻腔吻合术中留置物不同分成2组；A组为气囊导尿管组，B组为明胶海绵组，详细资料见表1。
1.2方法 术前5min先用2～3片5g/L的卡因和10g/L肾上腺素浸湿的棉片置入术侧下鼻道前上方收敛下鼻道并麻醉鼻粘膜。沿泪嵴部向下外切开，长约1.2～1.5cm，分离皮下组织及内眦韧带，分离出泪前嵴，划开骨膜，咬骨钳咬去泪骨凹槽，在泪囊粘膜和鼻粘膜上做“工”形切口，泪囊粘膜后唇和鼻粘膜后唇间断缝合一针至两针。气囊导尿管组：鼻粘膜内伸入双腔小号气囊导尿管并注水1～2mL，见导尿管顶端膨起成一球状正好下压后唇（泪囊与鼻粘膜），上顶前唇，前唇间断缝合2针，缝合皮下组织及皮肤切口。5d后拔管。明胶海绵组：将明胶海绵做成烟卷式从吻合处进入伸入鼻前庭并压迫后唇，前唇缝2针，如有创面出血可在明胶海绵上点少许付肾上腺素止血。缝合皮下组织与皮肤切口，冲泪道通畅后，绷带加压。3～5d后拔除。