泪道阻塞是临床常见的眼科疾病,主要表现为溢泪、反复感染等症状,严重影响患者的生活质量。传统治疗方法主要采用硅胶或金属支架置入术,这些材料虽然能够暂时维持泪道通畅,但由于其不可降解性、容易移位、易形成生物膜导致感染等固有缺陷,往往需要二次手术取出,给患者带来额外的痛苦和经济负担。随着材料科学和生物医学工程的发展,新型支架材料的研发为解决这些问题提供了新的思路。文章聚焦新型材料如可降解材料、3D打印个性化支架、复合材料及表面改性技术等,这些材料可通过材料降解、精准适配或多功能整合提升临床疗效,但在降解速率调控、3D打印精度及成本方面仍面临诸多挑战。此外,这些新技术的长期安全性和有效性还需要更多临床数据的支持,在未来仍需不断探索,开发更精准的降解速率调控方法,优化3D打印流程以提高精度,降低材料制备的成本,探索更高效的复合材料制备技术。同时,要加强基础研究,推动更多创新技术在临床的应用,开发出更安全、更有效的新型泪道支架材料,为泪道阻塞患者提供更优质的治疗方案,推动泪道疾病治疗向精准微创化方向发展。
Lacrimal duct obstruction is a common clinical ophthalmic condition characterized by symptoms such as epiphora and recurrent infections, significantly impairing patients' quality of life. Traditional treatments primarily involve the implantation of silicone or metal stents. While these materials can temporarily maintain lacrimal duct patency, their inherent drawbacks—such as non-degradability, susceptibility to displacement, and tendency to form biofilms leading to infections—often necessitate secondary surgeries for removal, imposing additional physical and financial burdens on patients.Advances in materials science and biomedical engineering have introduced novel stent materials as potential solutions to these challenges. This article focuses on emerging materials such as biodegradable polymers, 3D-printed personalized stents, composite materials, and surface modification technologies. These innovations can enhance clinical outcomes through material degradation, precise customization, or multifunctional integration. However, challenges remain in regulating degradation rates, improving 3D printing precision, and reducing costs.Furthermore, the longterm safety and efficacy of these technologies require more clinical data for validation. Future research should explore more precise degradation rate control methods, optimize 3D printing processes to enhance accuracy, lower material production costs, and develop more efficient composite material fabrication techniques. Concurrently, strengthening fundamental research and promoting the clinical application of innovative technologies will be crucial to developing safer and more effective lacrimal duct stent materials. Such advancements will provide superior treatment options for patients with lacrimal duct obstruction and drive the field toward minimally invasive and precision medicine approaches.
泪道肿瘤是比较罕见的泪道疾病。文献报道有超过55%的泪道肿瘤为恶性肿瘤,如果肿瘤不能完全切除或已经发生转移,可能会使复发率和死亡率增加。故临床上对表现为泪囊肿物的病例应详细检查,比如眼眶彩色多普勒超声、计算机断层扫描(computed tomography, CT)及磁共振成像(magnetic resonance imaging, MRI)检查,必要时行增强扫描,有条件还可以进行泪道内镜检查,充分预估病情,设计合理的手术入路和切除范围。如肿物较大或病情复杂,经过皮肤或者鼻内镜下入路作单一切口不能完整切除,可以内外路联合手术,以获得良好的视野,对肿物进行充分的游离分离,进行合适的切除。文章汇报了通过皮肤切口联合鼻内镜入路完成的2例泪道肿瘤切除术,1例术后病理为良性的乳头状瘤,术后5个月时复查未见复发,长期观察;另一例为NUT癌,确诊后患者已经至肿瘤科接受了化学治疗。提示表现为泪囊肿物的病例在术前应完善眼眶影像学检查,怀疑为恶性肿瘤时应完善全身重要脏器的检查,以充分评估病情。对于有手术指征的应选择合适的手术方案,尽量完整切除。术后应长期随访,以早期发现复发和转移,及时治疗。
Lacrimal tumors are a relatively rare disease of the lacrimal system. According to the literature, more than 55% of lacrimal tumors are malignant tumors. If the tumor cannot be completely removed or has already metastasized, it may increase the recurrence rate and mortality rate. Therefore, in clinical practice, if a case of a mass in the lacrimal sac is encountered, a thorough examination should be performed, such as orbital ultrasound scan, CT and MRI with or without contrast enhancement, and endoscopic examination of the lacrimal duct, if possible. The condition should be fully assessed to design a reasonable surgical approach and the extent of surgical resection. If the lesion is large or the condition is complex, a single incision through the skin or endoscopic approach may not be able to completely remove it, and an combined approach can be used to obtain a good view and fully dissect and separate the lesion for appropriate resection. This article reports two cases of lacrimal tumor resection performed through a skin incision combined with an endoscopic approach, one of which had a postoperative pathological diagnosis of benign papilloma and no recurrence was observed.5 months after surgery and Long-term follow-up is planned. The other case was NUT carcinoma. The patient had received chemotherapy in the oncology department of the general Hospital after diagnosis. It is suggested that the imaging examination of the orbit should be improved in the case of lacrimal tumor before operation, and the examination of the main organs of the body should be perfected when malignant tumor is suspected, so as to fully evaluate the condition. For the case with surgical indications, the appropriate surgical plan should be selected and the complete resection should be carried out as much as possible. Long-term follow-up should be carried out after surgery, so that recurrence and metastasis can be detected early, and timely treatment can be carried out.
目的:探讨完善泪道成形+义管植入日间手术患者的延续性护理对预防义管意外脱管的重要作用。方法:收集我科2016年1月至12月实施了标准延续性护理的泪道成形+义管植入日间手术患者的意外脱管情况。结果:泪道成形+义管植入日间手术患者随访期间没有发生医源性脱管,有9例9眼带管期间在院外发生脱管,意外脱管率为2.6%。结论:做好泪道成形+义管植入日间手术患者的延续性护理,有效降低义管意外脱出率,有利于患者康复。
Objective: To explore the important role of continuous nursing of the patients with day surgery of lacrimal duct forming combined tube implantation in the aspect of accident prevention to take off the tube. Methods: The information of the patients from Jan. to Dec. 2016 with accident the tube’s takeoff after carrying out the standard continuity of care were collected. Results: There was no iatrogenic but 9 eyes of 9 patients accidentally take off the tube during follow-up period. Accidental decannulation rate was 2.6%. Conclusion: Continuous care of the patients with day surgery of lacrimal duct forming combined tube implantation can effectively reduce the tube accidentally removal rate and be beneficial to patients’ recovery.
目的:探讨改良的外路泪囊鼻腔吻合术式联合泪道置管治疗泪囊黏液囊肿的临床疗效。
方法:对23例(23眼)泪囊黏液囊肿行改良式泪囊鼻腔吻合术,并联合泪道置管,术后行泪道冲洗,并观察泪溢情况。结果:23例患者,1例术中改为泪囊摘除术,20例完成12个月的追踪观察治疗,1例术后6个月失访,1例12个月时失访。随访1个月,22例患者术后泪囊肿均消失,外观明显改善;随访12个月,20例患者中18例溢泪症状完全消失,所有患者泪道冲洗通畅,仅1例患者因泪溢症状对手术疗效不满意。
结论:改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿,具有良好的临床效果值得推广。
Purpose: To investigate the eficacy of modified external dacrocystorhinostomy (DCR) with intubation in the treatment of lacrimal sac cys.
Methods: Twenty-three lacrimal sac cyst cases (23 eyes) were enrolled and treated with DCR technique and tube intubation. The success was assessed based on lacrimalirrigation and symptomatic relief of epiphora.
Results: Among 23 patients, surgery was intenupted and converted to dacryocystectomy in l case, thus surgery was successfully performed in 22 cases. Among them, 1 case lost follow up at 6 month, 1 case lost follow up at 12 month. At 1 month visit, lacrimal sac cyst disappeared in 22 cases. At 12 month visit, epiphora was completed relieved in 18 out of 20 cases, irrigation indicated no obstruction in all 20 cases.
Conclusions :The modified DCR technique with intubation has satisfactory outcome for lacrimal sac cyst.