CAJ | 학술논문

目的总结因颞侧眼睑挫伤牵拉间接引起泪小管断裂,表现为泪小管撕裂伤病例的临床特征、手术方法、治疗效果及并发症.方法回顾性分析温州医学院附属眼视光医院2004年1月到2010年1月诊治的颞侧皮肤挫伤致泪小管撕裂伤患者93例(93眼),对其致伤原因、损伤特点、泪小管鼻侧断端查找方法、手术方法、疗效及术后并发症进行总结分析.对数据进行分类计数,求百分比.结果 93例患者泪小管撕裂均为车祸、拳击、坠地等钝挫伤从水平方向牵拉眼睑所致,其内眦部眼睑撕裂伤口较长,创面组织结构紊乱,泪小管鼻侧断端常位于内眦角内后方深部组织内,并靠近泪总管,术中除2例因断端组织严重紊乱,放弃行泪小管吻合术外,其余91例经直视下或经泪总管均查找到鼻侧断端；89例行一期泪小管吻合术,2例陈旧性病例行二期泪小管泪囊吻合术.该91眼均放置泪道支撑管,于术后3～6个月拔除支撑管.拔管后随访病例85例,77例(91％)泪道通畅,6例(7％)狭窄,2例阻塞.少数病例出现支撑管脱落、泪点轻度外翻、泪小管裂开等并发症.结论泪小管撕裂伤为颞侧眼睑挫伤从水平方向牵拉致泪小管断裂的特殊类型,了解泪小管鼻侧断端靠近泪总管的临床特征,有利于术中查找.放置泪道支撑物的吻合术为有效的治疗泪小管撕裂伤的方法.
목적 총결인섭측안검좌상견랍간접인기루소관단렬,표현위루소관시렬상병례적림상특정、수술방법、치료효과급병발증.방법 회고성분석온주의학원부속안시광의원2004년1월도2010년1월진치적섭측피부좌상치루소관시렬상환자93례(93안),대기치상원인、손상특점、루소관비측단단사조방법、수술방법、료효급술후병발증진행총결분석.대수거진행분류계수,구백분비.결과 93례환자루소관시렬균위차화、권격、추지등둔좌상종수평방향견랍안검소치,기내자부안검시렬상구교장,창면조직결구문란,루소관비측단단상위우내자각내후방심부조직내,병고근루총관,술중제2례인단단조직엄중문란,방기행루소관문합술외,기여91례경직시하혹경루총관균사조도비측단단；89례행일기루소관문합술,2례진구성병례행이기루소관루낭문합술.해91안균방치루도지탱관,우술후3～6개월발제지탱관.발관후수방병례85례,77례(91％)루도통창,6례(7％)협착,2례조새.소수병례출현지탱관탈락、루점경도외번、루소관렬개등병발증.결론 루소관시렬상위섭측안검좌상종수평방향견랍치루소관단렬적특수류형,료해루소관비측단단고근루총관적림상특정,유리우술중사조.방치루도지탱물적문합술위유효적치료루소관시렬상적방법.
Objective To investigate the clinical features,treatment,therapeutic effect and complications of canalicular laceration indirectly caused by temporal blepharal contusion.Methods This study retrospectively analyzed 93 patients (93 eyes) with lacrimal canalicular laceration admitted to the Eye Hospital of Wenzhou Medical College from January 2004 to January 2010.Nosogenesis,features,methods for finding the nasal broken end of lacrimal canaliculus,treatment,therapeutic effect and postoperative complications of canalicular laceration indirectly caused by temporal blepharal contusion were summarized and analyzed,and described in percentages.Results Lacrimal canalicular laceration in all 93 eyes was caused by temporal blepharal contusion,such as a traffic accident,boxing or tumbling.The laceration in the eyelid of the inner canthus was very long,and the structure of the wound was not clean-cut.The nasal end of the broken lacrimal canalicoli was located in deeper tissue,close to the common canaliculus.All the paranasal broken ends were found directly or from the common lacrimal duct except for two patients whose treatments were terminated because of disorganized abrupt ends.Primary anastomosis of the lacrimal canal was performed on 89 patients,and secondary anastomosis of the canaliculus-to-lacrimal sac was performed on 2 patients.A support tube was implanted in each of 91 patients with canalicular laceration,then extubated 3 to 6 months after the operation.Follow-up observation of the 85 eyes showed completo patency in 77 patients (91％),stenosis of the canaliculus in 6 patients (7％) and obstruent canaliculus was still present in 2 patients.A few cases presented with abscission of the support tube,ectropion of the lacrimal point,or dehiscence of the canaliculi.Conclusion As a special type of caualicular injury,indirect canalicular laceration is caused by temporal blepharal contusion due to the horizontal tractive force action on the eyelid.Understanding the clinical features of the nasal end broken close to the common canaliculus helps in locating the abrupt ends.And anastomosis with a support tube is an effective treatment method.