背景:尽管鼻泪管探通术是儿童先天性鼻泪管阻塞(CNLDO)的标准治疗方法,这个程序的最佳时机一直是争论的话题。该研究的目的是分析不同年龄段有CNLDO症状的患者鼻泪管探通的临床疗效。
方法:一项为期8年的回顾性研究涉及2434例患者(3009只眼),在手术室局部麻醉下进行鼻泪管探查。研究组由1148名女孩(47.2%)和1286名男孩(52.8%)组成,年龄从2周到41个月(平均年龄为8±5.6个月)。参与者分为9个年龄组:0-2个月,3-6个月,7-9个月,10-12个月,13-15个月,16-18个月,19-21个月,22-24个月及24个月以上。
结果:与单侧梗阻患者相比,575例(23.6%)儿童存在双侧梗阻,且手术不成功的比例更高(16.9%vs10.2%,p<0.001卡方检验)。所有儿童的初次探查成功率为87.2%,并显示其随年龄增长而降低。在上述年龄组中,为87.9%;91.4%;89.6%;86%;76.3%;70.3%;70.2%;65.4%,分别。
结论:探查是一种安全有效的方法。然而,初次介入时的年龄和双侧手术是探查失败的重要危险因素.对于没有反复感染的儿童,在7到9个月之间进行探索似乎是合理的治疗策略。对于有其他体征的患者,可以考虑早期手术干预。
BACKGROUND: Although nasolacrimal duct probing is the standard treatment for congenital nasolacrimal duct obstruction (CNLDO) among children, the optimal timing of this procedure has been a topic of debate. The aim of the study was to analyze the clinical efficacy of nasolacrimal duct probing among patients with CNLDO symptoms at various ages.
METHODS: An 8-year retrospective study involved 2434 patients (3009 eyes), who underwent nasolacrimal duct probing conducted under topical anesthesia in the operating theatre. The study group consisted of 1148 girls (47.2%) and 1286 boys (52.8%) from 2 weeks to 41 months (average age was 8 ± 5.6 months). The participants were divided into nine age groups: 0-2 months, 3-6 months, 7-9 months, 10-12 months, 13-15 months, 16-18 months, 19-21 months, 22-24 months and over 24 months.
RESULTS: Bilateral obstruction was present among 575 (23.6%) children and was associated with a higher percentage of unsuccessful procedures compared to patients with unilateral obstruction (16.9% vs 10.2%, p < 0.001 Chi-square test). The success rate of the initial probing was 87.2% for all children and it was shown that it decreased with age. In the above age groups, it was 87.9%; 91.4%; 89.6%; 86%; 76.3%; 71.3%; 70.3%; 70.2%; 65.4%, respectively.
CONCLUSIONS: Probing is a safe and effective procedure. However, age at the time of the initial intervention and bilateral surgery constitute significant risk factors for failed probing. Probing between 7 and 9 months appears to be reasonable treatment strategy for children without recurrent infections. Early surgical intervention may be considered for patients with additional signs.