气囊扩张术治疗小儿科鼻泪管阻塞

能安全、有效地治疗顽固性阻塞

  3月份出版的《美国眼科学杂志》发表了一篇文章,记载了干预治疗的一系列案例,结果发现,球型导液管能安全有效地治疗儿童的顽固性鼻泪管阻塞。

  尽管鼻泪管阻塞通常在出生后的前几个月能得到解决,但是有时需要外科导管探查术。

  Gregg T. Lueder就职于圣·路易斯的华盛顿大学医学院。他和同事写到:「气囊导管扩张术能安全有效地治疗外科手术后出现顽固性鼻泪管阻塞症状的患儿。」

  受试者包括32名患儿,平均年龄为15个月,他们在早期外科手术后出现了顽固性鼻泪管阻塞症状,其中20名患儿为双侧鼻泪管阻塞,12名患儿为单侧鼻泪管阻塞。面部外伤史、系统障碍包括泪系统或鼻泪管囊肿的患儿被排除在外。

  末梢鼻泪管气囊导管扩张术,对9名患儿的疗效极佳(28%),对15名患儿(47%)的疗效良好,对7名患儿的疗效尚可(22%),对1名患儿(3%)疗效差。在经历了不止1次外科手术的7名患儿中,有3名疗效极佳,2名疗效良好,1名疗效尚可,1名疗效差。

  若患者的症状如溢泪和泪囊炎完全改善以及检查发现泪液排泄正常,被认为疗效极佳;若患者仅有轻微的遗留症状或染料排泄轻微延迟被认为疗效好;若患者有中度的遗留症状或染料排泄延迟,被认为疗效尚可;若没有任何改善,被认为疗效差。

  作者写到:「直接比较气囊导管扩张术和支架放置术治疗顽固性鼻泪管阻塞很困难,因为很多以前的报导称,矽酮插管法不能分辨那些以前经历了外科手术和未经历外科手术的患儿。气囊导管扩张术的主要有利之处在于支架不能留在鼻泪管系统。气囊导管扩张术避免了支架放置术治疗可能出现的几个潜在问题。」

Balloon Dilation Treats Pediatric Nasolacrimal Duct Obstruction

Safe, Effective in Persistent Obstruction

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

April 5, 2002 -- Balloon catheters safely and effectively treat persistent nasolacrimal duct obstruction in children, according to an interventional case series in the March issue of the American Journal of Ophthalmology.

Although nasolacrimal duct obstruction usually resolves in the first few months of life, surgical probing of the duct is sometimes needed.

"Balloon catheter dilation is a safe and generally effective treatment for children with persistent symptoms of nasolacrimal duct obstruction following previous surgery," write Gregg T. Lueder and colleagues from Washington University School of Medicine in St. Louis.

Of 32 consecutive children, mean age 15 months, with a history of persistent nasolacrimal duct obstruction following previous surgery, 20 had bilateral and 12 had unilateral nasolacrimal duct obstruction. Patients with a history of facial trauma, systemic disorders involving the lacrimal system, or nasolacrimal duct cysts were excluded.

Balloon catheter dilation of the distal nasolacrimal duct led to outcomes which were excellent in nine patients (28%), good in 15 patients (47%), fair in seven patients (22%), and poor in one patient (3%). In seven patients who had undergone more than one previous surgery, outcome was excellent in three, good in two, fair in one, and poor in one.

Outcomes were considered excellent if the patient had complete symptomatic resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement.

"Direct comparison of balloon catheter dilation to stent placement for treatment of persistent nasolacrimal duct obstruction is difficult, because most previous reports of silicone intubation have not separated patients into those who had undergone previous surgery and those who had not," the authors write. "The primary advantage of balloon catheter dilation over lacrimal stent placement is that a stent is not left in the nasolacrimal system. This avoids several potential problems that may occur in patients treated with stents."

© 2002 WebMD Inc. All rights reserved.

    



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