有泪囊脓肿切开史的先天性鼻泪管阻塞病例手术治疗分析
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摘要
目的观察分析曾行泪囊脓肿切开的先天性鼻泪管阻塞患儿泪道阻塞的病例特点及手术疗效。方法回顾分析22例(24眼)曾行泪囊脓肿切开的先天性鼻泪管阻塞患儿病史及病例特点,行CT检查了解骨性泪道发育情况,采用Ritleng泪道插管术或鼻内窥镜下鼻腔泪囊吻合术进行手术治疗,对治疗效果及并发症进行总结。结果 24眼中,合并骨性鼻泪管发育异常14眼(58.3%),其中骨性狭窄12眼,骨性闭锁2眼,所有患儿遗留泪囊区皮肤瘢痕。不合并骨性泪道发育异常者10眼,其中泪囊突出2眼,复杂性鼻泪管阻塞8眼。不合并骨性泪道发育异常者采用Ritleng泪道插管术治疗,合并骨性泪道发育异常者采用鼻内窥镜下鼻腔泪囊吻合术,共治愈21眼(21/24,87.5%),好转2眼,无效1眼。结论泪囊脓肿反复发作的先天性鼻泪管阻塞患儿泪道发育情况较为复杂,不应盲目行泪囊脓肿切开,不合并骨性泪道发育异常的患儿可行泪道插管术,对于合并骨性鼻泪管发育异常患儿需行鼻窦内窥镜下鼻腔泪囊吻合术。
Objective To observe the etiological features and surgical effects of congenital lacrimal duct obstruction in children after incision of lacrimal sac abscess. Methods Retrospective analysis the history and clinical characteristics of22 cases with congenital nasolacrimal duct obstruction(24 eyes) after incision of lacrimal sac abscess, and explore the radiographic characteristics of nasolacrimal canals. Ritleng lacrimal intubation or nasal endoscopic daciyocystorhinostomy(NES-DCR) were prefonned. The therapeutic effect was analyzed and the complications were observed. Result There were14 eyes with nasolacrimal canal agenesis( 58. 3%), including 12 eyes with bony stenosis and 2 eyes with atresia. All the patients had scar in the daciyocyst area. Ten eyes without nasolacrimal canal agenesis, including 8 eyes with complex obstruction,2 eyes with daciyocystocele. Ritleng lacrimal intubation was performed in patients without nasolacrimal canal agenesis. Nasal endoscopic daciyocystorhinostomy(NES-DCR) were prefonned in patients with nasolacrimal canal agenesis. The total cure rate was 87. 5%(21/24), 2 eye had improved, 1 eye had no effect. Conclusion Recurrent lacrimal sac abscess probably exist with complex etiological features. Incision of lacrimal sac abscess should not be performed blindly. Lacrimal intubation should be performed in these patients without nasolacrimal canal agenesis and NES-DCR with nasolacrimal canal agenesis.
Objective To observe the etiological features and surgical effects of congenital lacrimal duct obstruction in children after incision of lacrimal sac abscess. Methods Retrospective analysis the history and clinical characteristics of22 cases with congenital nasolacrimal duct obstruction(24 eyes) after incision of lacrimal sac abscess, and explore the radiographic characteristics of nasolacrimal canals. Ritleng lacrimal intubation or nasal endoscopic daciyocystorhinostomy(NES-DCR) were prefonned. The therapeutic effect was analyzed and the complications were observed. Result There were14 eyes with nasolacrimal canal agenesis( 58. 3%), including 12 eyes with bony stenosis and 2 eyes with atresia. All the patients had scar in the daciyocyst area. Ten eyes without nasolacrimal canal agenesis, including 8 eyes with complex obstruction,2 eyes with daciyocystocele. Ritleng lacrimal intubation was performed in patients without nasolacrimal canal agenesis. Nasal endoscopic daciyocystorhinostomy(NES-DCR) were prefonned in patients with nasolacrimal canal agenesis. The total cure rate was 87. 5%(21/24), 2 eye had improved, 1 eye had no effect. Conclusion Recurrent lacrimal sac abscess probably exist with complex etiological features. Incision of lacrimal sac abscess should not be performed blindly. Lacrimal intubation should be performed in these patients without nasolacrimal canal agenesis and NES-DCR with nasolacrimal canal agenesis.
引文
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[6]曹文红,吴倩,樊云葳等.Ritleng泪道插管术治疗儿童复杂性难治性泪道阻塞的效果观察.眼科,2011,20(5):302-306.
[7]张诚玥,于刚,吴倩等.先天性骨性鼻泪管发育异常的影像学观察.中华眼科杂志,2014,50(12):911-914.
[8]Chengyue Zhang,Gang Yu,Yanhui Cui,et al.Anatomical Characterization of the Nasolacrimal Canal Based on Computed Tomography in Children With Complex Congenital Nasolacrimal Duct Obstruction.J Pediatr Ophthalmol Strabismus,2017;54(4):238-243.
[9]Dagi LR,Bhargava A,Melvin P,et al.Associated sign,demographic characteristics,and management of daciyocystocele in 64 infants.J AAPOS,2012,16(3):255-260.
[10]Yasser H Al-Faky,Ahmed Mousa,Hatem Kalantan,etal.A prospective,randomised comparison of probing versus bicanalicular silastic intubation for congenital nasolacrimal duct obstruction.Br J Ophthalmol,2015,99(2):246-250.
[11]王媛,于刚,曹文红等.手术年龄对于Ritleng泪道插管术治疗儿童先天性鼻泪管阻塞疗效的影响.中国斜视与小儿眼科杂志,2014,22(4):22-24.
[12]Chan W,Wilcsek G,Ghabrial R.et al.Pediatric endonasal dacryocystorhinostomy:A multicenter series of 116 cases.Orbit.2017,36(5):311-316.
[13]崔燕辉,于刚,范金鲁,等.经鼻鼻腔泪囊吻合术治疗儿童复杂性泪道阻塞的临床观察.眼科,2015,24(3):171-176.
[2]Baskin DE,Reddy AK,Chu YI,et al.The timing of antibiotic administration in the management of infant daciyocystitis.J AAPOS,2008,12(5):456.
[3]王弘,宋蕾.新生儿急性泪囊炎的治疗.中国斜视与小儿眼科杂志,2011,19(1):38-40.
[4]杨少武,张志明,丁红.泪囊脓肿切开引流术后的泪囊鼻腔吻合.眼外伤职业眼病杂志,1999,21(2):621.
[5]张诚玥,于刚,吴倩等.先天性鼻泪管阻塞CT泪囊造影及骨性鼻泪管测量初步研究.眼科,2011,20(5):207-310.
[6]曹文红,吴倩,樊云葳等.Ritleng泪道插管术治疗儿童复杂性难治性泪道阻塞的效果观察.眼科,2011,20(5):302-306.
[7]张诚玥,于刚,吴倩等.先天性骨性鼻泪管发育异常的影像学观察.中华眼科杂志,2014,50(12):911-914.
[8]Chengyue Zhang,Gang Yu,Yanhui Cui,et al.Anatomical Characterization of the Nasolacrimal Canal Based on Computed Tomography in Children With Complex Congenital Nasolacrimal Duct Obstruction.J Pediatr Ophthalmol Strabismus,2017;54(4):238-243.
[9]Dagi LR,Bhargava A,Melvin P,et al.Associated sign,demographic characteristics,and management of daciyocystocele in 64 infants.J AAPOS,2012,16(3):255-260.
[10]Yasser H Al-Faky,Ahmed Mousa,Hatem Kalantan,etal.A prospective,randomised comparison of probing versus bicanalicular silastic intubation for congenital nasolacrimal duct obstruction.Br J Ophthalmol,2015,99(2):246-250.
[11]王媛,于刚,曹文红等.手术年龄对于Ritleng泪道插管术治疗儿童先天性鼻泪管阻塞疗效的影响.中国斜视与小儿眼科杂志,2014,22(4):22-24.
[12]Chan W,Wilcsek G,Ghabrial R.et al.Pediatric endonasal dacryocystorhinostomy:A multicenter series of 116 cases.Orbit.2017,36(5):311-316.
[13]崔燕辉,于刚,范金鲁,等.经鼻鼻腔泪囊吻合术治疗儿童复杂性泪道阻塞的临床观察.眼科,2015,24(3):171-176.