CAJ | 학술논문

目的探讨单纯泪腺肿瘤摘除术对眼表泪膜及泪液分泌的影响.方法回顾性系列病例研究.选择2010年1月至201 1年6月在复旦大学附属眼耳鼻喉科医院眼科行泪腺肿瘤摘除术的泪腺多形性腺瘤患者19例(19只眼).观察分析其术前、术后3d、1个月、6个月的主观感觉、泪膜破裂时间(BUT)、角膜荧光素染色、相干光断层扫描仪测量下泪湖面积、Schirmer Ⅰ试验及SchirmerⅡ试验(反射性泪液分泌)结果.比较各项结果在术前与术后不同时间以及术眼与对侧眼的差异.干眼症状采用配对秩和检验.荧光素染色、BUT、反射性泪液分泌及泪湖面积检查采用配对t检验.结果与术前相比,患者术后3d、1个月时不适主诉增加,术眼角膜荧光素着色点明显增多,术眼BUT、SchirmerⅡ试验及泪湖面积分别为(4.9±2.0)s(3 d),(5.2±1.6)s(1个月)；(4.05 ±2.07) mm(3 d),(3.58±1.98)mm(1个月)；(0.009 ±0.004)mm2(3 d),(0.008±0.003) mm2(1个月).较术前缩短,差异有统计学意义(术后3 d:t =23.91,16.90,11.47,P＜0.05；术后1个月:t=19.31,20.81,11.95,P＜0.05)；术后6个月时SchirmerⅡ试验为(3.53±1.50) mm,仍较术前缩短,差异有统计学意义(t=21.57,P＜0.05),但角膜荧光素着色点减少,BUT、泪湖面积分别为(17.4±4.9)s,(0.032±0.005) mm2,接近术前水平,差异没有统计学意义(t=0.23,1.69,P＞0.05).与对侧眼对照,与术前对照比较结果相同.结论泪腺多形性腺瘤患者肿瘤摘除术后可出现泪膜异常改变,尤其表现为泪膜稳定性下降及反射性泪液分泌减少.
목적 탐토단순루선종류적제술대안표루막급루액분비적영향.방법 회고성계렬병례연구.선택2010년1월지201 1년6월재복단대학부속안이비후과의원안과행루선종류적제술적루선다형성선류환자19례(19지안).관찰분석기술전、술후3d、1개월、6개월적주관감각、루막파렬시간(BUT)、각막형광소염색、상간광단층소묘의측량하루호면적、Schirmer Ⅰ시험급SchirmerⅡ시험(반사성루액분비)결과.비교각항결과재술전여술후불동시간이급술안여대측안적차이.간안증상채용배대질화검험.형광소염색、BUT、반사성루액분비급루호면적검사채용배대t검험.결과 여술전상비,환자술후3d、1개월시불괄주소증가,술안각막형광소착색점명현증다,술안BUT、SchirmerⅡ시험급루호면적분별위(4.9±2.0)s(3 d),(5.2±1.6)s(1개월)；(4.05 ±2.07) mm(3 d),(3.58±1.98)mm(1개월)；(0.009 ±0.004)mm2(3 d),(0.008±0.003) mm2(1개월).교술전축단,차이유통계학의의(술후3 d:t =23.91,16.90,11.47,P＜0.05；술후1개월:t=19.31,20.81,11.95,P＜0.05)；술후6개월시SchirmerⅡ시험위(3.53±1.50) mm,잉교술전축단,차이유통계학의의(t=21.57,P＜0.05),단각막형광소착색점감소,BUT、루호면적분별위(17.4±4.9)s,(0.032±0.005) mm2,접근술전수평,차이몰유통계학의의(t=0.23,1.69,P＞0.05).여대측안대조,여술전대조비교결과상동.결론 루선다형성선류환자종류적제술후가출현루막이상개변,우기표현위루막은정성하강급반사성루액분비감소.
Objective To study the change of tear film and lacrimal secretion after lacrimal gland tumor removal operation.Methods It was a retrospective case series study.Nineteen cases (19 eyes) with pleomorphic adenoma of the lacrimal gland from January,2010 to July,2011 in Eye and ENT Hospital of Fudan University were elected.The evaluation included subjective complaints of dry eye,tear break up time (BUT),reflex lacrimal secretion,corneal fluorescein staining,and size of lacrimal lake were analyzed before surgery and 3 days,1 month and 6 months postoperatively.Simultaneously,the opposite eye was set as control.Results Subjective complaints of dry eye increased and the mean tear break up time,reflex lacrimal secretion,and size of lacrimal lake were significantly reduced (t =23.91,16.90,11.47 ; t =19.31,20.81,11.95,P ＜ 0.05) on day 3 and 1 month after operation which were (4.9 ± 2.0) s (3 d),(5.2 ± 1.6) s (1 moth) ; (4.05 ± 2.07) mm (3 d),(3.58 ± 1.98) mm (1 moth) ; (0.009 ± 0.004) mm2 (3 d),(0.008 ±0.003) mm2 (1 moth) respectively.However,only reflex secretion test (3.53 ± 1.50 mm) was significantly reduced (t =21.57,P ＜ 0.05),other values (BUT:17.4 ± 4.9 s,size of lake:0.032 ± 0.005 mm2)recovered to preoperative levels by the time of the sixth month follow up visit.Corneal fluorescein staining score increased greatly when measured at day 3 and 1 month visit (t =0.23,1.69,P ＜ 0.05),but had returned to preoperative values at the sixth month visit.The result of the opposite eye control is the same as preoperative control.Conclusions During the early stage after lacrimal gland tumor removal,tear film present abnormal changes,mainly in tear stability and reduction of reflex lacrimal secretion.