上下泪小管同时断裂环形置管术临床应用.docVIP

上下泪小管同时断裂环形置管术临床应用【摘要】 目的 观察上下泪小管同时断裂吻合术中环形置管术的疗效及手术方法。方法 10眼上下泪小管断裂均施行环形置管术。结果 10眼泪小管断裂均成功施行环形置管术,置入硬膜外麻醉导管,术后2~3个月拔管,最长追踪1年,上下泪道冲洗通畅无泪溢者9眼,上下泪道通而不畅但无明显泪溢者1眼,无1眼下泪小点外翻。结论 上下泪小管断裂吻合适合施行环形硬膜外麻醉导管置管术,既修复了上下泪小管断裂,又防止了术后泪小点、眼睑外翻,且义管不易脱出。 【关键词】 上下泪小管同时断裂; 环形置管; 竖形穿刺 Clinical application of circle tubing technique in rupture of superior and inferior lacrimal canaliculi ZHANG Qian-wei.Zaozhuang city,Shangdong Province Hospital,277100,China 【Abstract】 Objective Observe the effectiveness and methods of surgery In rupture of superior and inferior lacrimal canaliculi.Methods 10 cases with rupture of superior and inferior lacrimal canaliculi recerived circle tubing surgery. Results 10 cases with rupture of superior and inferior lacrimal canaliculi recerived sucessful circle tubing surgery. Tube was removed postoperative 2~3 months.The longest follow-up time is one year 9 eyes were flowed smoothly with no epiphora. 1 eye was not flowed smoothly with no epiphora. No one eye has inferior lacimal ectropion. Conclusion Circle tubing technique in rupture of superior and inferior lacrimal canaliculi is not only cure rupture of lacrimal canaliculi, but aslo prevent the ectropion of puncta and eyelids.Artificial tube is not easy pull away. 【Key words】 Rupture of superior and inferior lacrimal canaliculi;Circle tubing;Upright puncture 外伤性泪小管断裂容易造成终生泪溢,显微镜下上下泪小管吻合环形置管术是恢复泪道畅通的最佳手术方法,特别是上下泪小管同时断裂。现对10例上下泪小管断裂患者显微镜下施行环形硬膜外麻醉导管置管术,取得了显著疗效。报告如下。 1 资料与方法 1.1 临床资料 本组10例,10只眼,均为男性,年龄16～55岁,平均31岁。新鲜外伤9例,陈旧外伤1例,致伤原因:拳脚伤、车祸、摔伤等。 1.2 手术方法 1.2.1 麻醉 2%利多卡因采用筛前及眶下神经阻滞麻醉及局部浸润麻醉。 1.2.2 显微镜直视下手术。 1.2.3 材料球后针头(针尖部磨平),硬膜外麻醉导管(取带圆头端约12～16 cm)。 1.2.4 手术方法 清理创口,稀释庆大霉素冲洗创面及结膜囊,探察断端,扩张上下泪小点进探针找到断端的远侧端,沿泪小管解剖及泪阜与泪小管的相对解剖位置直视下找到上、下泪小管鼻侧断端后,在拟置入的硬膜外麻醉导管壁靠近A端(为圆头端有侧孔,另一端为B端)约5 cm(以球后针头长度为基准)处做竖形穿刺口,大小以球后针头能进入为准,将球后针头从穿刺口插入硬膜外麻醉导管,至针头根部,将硬膜外麻醉导管以球后针头为支撑插入鼻侧断端,按解剖走向进入泪囊、鼻泪管至鼻腔,从球后针头用生理盐水冲洗确定导管已进入鼻腔后,拔出针头,穿刺口处自动闭合,再将导管置入约3 cm。扩张下泪小点,用探针插入泪小管出远侧断端,将硬膜外麻醉导管B端从泪小管远侧断端套入探针,缓缓将导管引出下泪小点