泪道插管圈套器的制作及其在泪道插管挂线扩张器植入术中的应用

目的自主设计制作一种取材、制作简易的泪道插管圈套器,用于辅助泪道阻塞再通术、泪小管断裂吻合术时协助泪道插管、挂线或扩张器的植入。方法随机选择慢性鼻泪管阻塞或合并慢性泪囊炎、急性外伤后泪小管断裂、鼻腔泪囊吻合术后吻合口狭窄阻塞患者206例,其中慢性鼻泪管阻塞或合并慢性泪囊炎者198例,鼻腔泪囊吻合术后吻合口狭窄阻塞者2例,泪小管断裂者6例;男性38例,女性168例;年龄5～82岁,平均年龄为（48.0±5.8）岁。用自制泪道插管圈套器辅助泪道插管完成泪道挂线,并观察评价其耗时、成功率及并发症。具体方法：用一根内置有钢丝的硬脊膜外导管,将其分成两段,有标记刻度带侧孔的头部一段作为泪道插管;另一段硬脊膜外导管的两端绞合,制成带柄的长轴约为7～8cm、短轴约为5～6cm的类椭圆形环状圈（取名为泪道插管圈套器）。在泪道插管前将泪道插管圈套器的环状段预先从前鼻孔向后部鼻腔插入,使环状段放置于鼻腔至鼻咽部内,再行上或下泪点泪道插管,插入泪道达鼻泪管下鼻道开口以下,穿入预先放置于下鼻道至后鼻孔区域的圈套器圆环中;继之牵引圈套器拉出前鼻孔,将套取的泪道插管牵引拉出前鼻孔;再将丝线固定于泪道插管头端,随后泪道插管逆行退出泪道,丝线即随泪道插管退出而穿入泪道完成泪道挂线术。最后可再与其他各种泪道扩张器连接完成泪道扩张器植入。结果用泪道插管圈套器圈套拉出泪道插管的206例完成泪道挂线的成功率为100%,平均时间92s。自制泪道插管圈套器辅助泪道插管完成泪道挂线术中部分病例有泪道和鼻腔少量出血,全部在5min内自止;术中术后无泪小点及泪小管撕裂或其他并发症。结论泪道插管圈套器可以简单有效地辅助完成硬脊膜外导管泪道插管、挂线或扩张器植入,使泪道插管、挂线或扩张器植?

A custom-made lacrimal duct intubation snare and its clinical application for implanting a tube,a hanging suture or a dilator in the lacrimal duct is described

Objective To design a simple lacrimal duct intubation snare that can be used as a supplementary instrument for intubation,for a hanging suture or for the implantation of a dilator in the lacrimal duct.Methods One eye of each of 206 cases with an obstruction of the nasolacrimal duct with or without chronic dacry-ocystitis,laceration of the canaliculus or stroma stenosis after dacryocystorhinostomy were randomly selected for the study.Of the 206 cases,198 were diagnosed with chronic obstruction of the nasolacrimal duct or chronic dacryocystitisin,2 cases were diagnosed with stroma stenosis after dacryocystorhinostomy,and 6 cases were diagnosed with laceration of the canaliculus.The mean age of the 38 men and 168 women was（48.0±5.8）years（range 5 to 82 years）.The operation to hang a line in the lacrimal duct was performed with a custommade lacrimal duct intubation snare.The amount of time needed,the success rate,and the complications were evaluated.The procedures were as follows：an epidural tube enclosing a steel wire was cut into two sections.The head of the epidural tube was scaled with lateral holes and used for the nasolacrimal duct intubation.The two ends of another piece of epidural tube were twisted and the extra section was cut off,creating an oval annular ring with a diameter of 5×7 cm（called a lacrimal duct intubation snare）.The annular ring of the lacrimal duct intubation snare was inserted first from the anterior nares to the posterior nares nasal septum,setting it between the nasal cavity and nasopharynx nasalis.The epidural tube entered the lacrimal duct through the superior or inferior lacrimal punctum and was inserted into the nasolacrimal duct under the inferior nasal meatus.The annular ring of the lacrimal duct intubation snare was then inserted.With the traction of the twisted section of the snare,the epidural tube entered the annular ring of the lacrimal duct intubation snare and was pulled out of the anterior nares.After a silk suture was fixated to the head end of the epidural tu