CAJ | 학술논문

目的探讨Ritleng泪道插管手术治疗泪道探通无效的先天性鼻泪管阻塞(CNLDO)的疗效及影响治愈率的各种相关因素.方法回顾性系列病例研究.收集2008年2月至2009年10月在北京儿童医院眼科行Ritleng泪道插管术治疗的CNLDO患儿的临床资料546例(616只眼),平均年龄11个月,随访6～17个月.分析年龄、泪道探通次数以及鼻泪管阻塞类型对患者治愈率的影响,同时对术中出血、水肿、假道形成等并发症进行总结.使用Pearson相关系数计算及独立样本t检验进行统计学分析.结果 616只眼中544只眼达到治愈标准,总治愈率为88％ (544/616).在≥6且＜12个月,≥12且＜24个月,≥24且＜36个月,≥36且＜48个月以及≥48个月这5个年龄组中,治愈率依次为96％( 94/98)、94％ (244/260)、87％( 104/119)、77％( 58/75)、69％ (44/64)(R=-0.98,P=0.003)；在进行过1次探通、2次探通以及2次以上探通的3个组中,治愈率分别为:95％ (291/304)、89％ (163/184)、70％ (90/128)(R=-0.99,P=0.050)；在单纯膜性鼻泪管阻塞类型中,治愈率为92％ (343/374),复杂性鼻泪管阻塞类型中治愈率为83％ (201/242)(P=0.000).主要并发症包括8只眼(1％)出现泪小点裂伤；14只眼(2％)出现假道形成,18只眼(3％)硅胶管脱出.结论 Ritleng泪道插管手术对于探通无效的CNLDO患儿有较好的疗效,具有较高的安全性,治愈率随年龄增长、探通次数的增加有明显下降趋势,单纯膜性鼻泪管阻塞较复杂性鼻泪管阻塞治愈率更高.
목적 탐토Ritleng루도삽관수술치료루도탐통무효적선천성비루관조새(CNLDO)적료효급영향치유솔적각충상관인소.방법 회고성계렬병례연구.수집2008년2월지2009년10월재북경인동의원안과행Ritleng루도삽관술치료적CNLDO환인적림상자료546례(616지안),평균년령11개월,수방6～17개월.분석년령、루도탐통차수이급비루관조새류형대환자치유솔적영향,동시대술중출혈、수종、가도형성등병발증진행총결.사용Pearson상관계수계산급독립양본t검험진행통계학분석.결과 616지안중544지안체도치유표준,총치유솔위88％ (544/616).재≥6차＜12개월,≥12차＜24개월,≥24차＜36개월,≥36차＜48개월이급≥48개월저5개년령조중,치유솔의차위96％( 94/98)、94％ (244/260)、87％( 104/119)、77％( 58/75)、69％ (44/64)(R=-0.98,P=0.003)；재진행과1차탐통、2차탐통이급2차이상탐통적3개조중,치유솔분별위:95％ (291/304)、89％ (163/184)、70％ (90/128)(R=-0.99,P=0.050)；재단순막성비루관조새류형중,치유솔위92％ (343/374),복잡성비루관조새류형중치유솔위83％ (201/242)(P=0.000).주요병발증포괄8지안(1％)출현루소점렬상；14지안(2％)출현가도형성,18지안(3％)규효관탈출.결론 Ritleng루도삽관수술대우탐통무효적CNLDO환인유교호적료효,구유교고적안전성,치유솔수년령증장、탐통차수적증가유명현하강추세,단순막성비루관조새교복잡성비루관조새치유솔경고.
Objective To evaluate the efficacy of the Ritleng lacrimal intubation system in the treatment of congenital nasolacrimal duct obstruction (CNLDO) after failed probing and to analyze the effect of various factors that affected the recovery rate.Methods Retrospective noncomparative case series.The outcome of 616 cases (eyes) of silicone intubation with the Ritleng lacrimal intubation system,performed between Feb.2008 and Oct.2009 on 546 children with CNLDO ( aged from 3 to 156 months with an average at 11 months) from Beijing Children's Hospital,was retrospectively reviewed.The follow-up period varied from 4 to 17 months (average 11 months).The effects of age,treatment history,and the type of obstruction on the recovery rate were evaluated and the complications such as epistaxis,lacrimal duct edema or silicone tube prolapse were recorded.The statistics analysis included Pearson correlation coefficient and independentsamples t-test.Results The overall recovery rate was 88％ (544/616 cases).In the five sub-groups based on the age,6 - 12 month,12 -24 month,24 -36 month,36 -48 month and older than 48 month age,the recovery rate was 96％ (94/98) ; 94％ (244/260) ; 87％ (104/119) ; 77％ (58/75) and 69％ (44/64),respectively ( R =-0.98,P =0.003).According to the times of previous probing,there were three groups,once,twice,and more than twice,the recovery rate was 95％ (291/304); 89％ (163/184) and 70％( 90/128 ),respectively ( R =- 0.99,P =0.050 ).In the simple membranous obstruction group and the complex obstruction group,the recovery rate was 92％ (343/374) and 83％ (201/242),respectively (P = 0.000).Complications included laceration of lachrymal point (8 eyes,1％ ) and false passage formation (14 eyes,2％ ).The silicone tube prolapsed in 18 eyes (3％).Conclusions The Ritleng lacrimal intubation system is an easy,effective and non-traumatic procedure for the treatment of CNLDO children after failed probing.Age of the patients,times of previous probing and type of obstruction influence the recovery rate.