The primary surgical treatment of the lacrimal canaliculi with injuries century

 

(57) Abstract:

The invention relates to medicine, ophthalmology. In the lacrimal point damaged lacrimal canaliculi introduce the cannula for washing lacrimal ducts with an outer diameter of 0.3-0.6 mm Inside the cannula is of a monofilament with a diameter of 0.1 mm After insertion of the cannula through the lacrimal point intact lacrimal canaliculi enter the spiral probe. Its end is brought out through the proximal division of the damaged lacrimal canaliculi. In the eye of the probe insert the line end of which is retrograde carried out through the tear path in the lacrimal point intact lacrimal canaliculi round. The cannula can be entered medicinal solutions. The method is simple, affordable, allows you to avoid stricture of lacrimal tubules.

The invention relates to medicine, namely to ophthalmology, and can be used when the wounds of the eyelids with damage to the lacrimal canaliculi in the provision of emergency care for PHO.

When traumatic separation or rupture of the lower eyelid from the inner spikes are observed injuries to the lower lacrimal canaliculus. It is well known that this kind of damage in the first place before the surgeon faces the task of restoring the anatomical clostest the capacity (as the main link) - participation in slezootdelenia. In some cases, such injuries are the most severe, accompanied by bleeding, the wound edges often edematous, crushed. This significantly complicates the reconstruction not only of the lower lacrimal canaliculus, but all the internal angle of the palpebral fissure ("Modern ophthalmology" edited by C. F. Danilichev, Saint-Petersburg., 2000, S. 397-398). Therefore, the development of methods PHO with injuries century with damage to the lacrimal tubules remains relevant.

Known way to restore the integrity of the lacrimal canaliculi, including the use of special spiral probe with a hole at the rounded end. In addition, of nylon fishing line cross-section of 0.6-0.8 mm make the rod. One end of the probe... to carry through the lacrimal point preserved canaliculi into the lacrimal SAC, and then retrograde into the proximal part of the torn canaliculi. Then into the hole of the probe insert the rod. Reverse rotation of the probe rod to be drawn into the lacrimal canals. Next, the probe is introduced into the other of the lacrimal point, and the second end of the mandrel retract into the distal section is broken canaliculi. On the edge of the tubule impose 2-3 submersible seam 08-99and the wound century sutured. The ends of the mandrel with periadrenal razor 2/3 thickness. After the involvement of this area in the lacrimal SAC rod easily folds in half and is not deforming the channel. Removing the mandrel after 2-3 weeks of no difficulty.

For the same purpose P. I. of Libechov proposes to use hollow screw probe taped, inside of which is placed polyvinyl vein cross-section of 0.4 mm (Galesville O. A., Gorban A. I. First aid in acute diseases and injuries of the eye. - L., Medicine, 1985. - S. 118-120). However, after removal of the mandrel does not exclude the possibility of development of cicatricial strictures damaged tubules.

Closest to the present invention is a method consisting in the following: in the lumen through the lower lacrimal point to the lacrimal SAC injected silicone or plastic tube-conductor (outer diameter 1.2 mm), on which the damaged tubule sew "end to end" (knotted stitches: nylon, silk, etc., 10/0), and then sutured and torn eyelid. Tube stitch (silk, 7/0, 8/0) and is securely fixed to the edge of the century (the seams easily erupt), and the remaining end is cut off at 0.5 mm above the lacrimal punctum. Remove the tube from the tubule after 1-2 months. Through it intact lacrimal canaliculus in the postoperative period production line on the lower lacrimal canaliculus in the wound is still not found, it is advisable to try his retrograde sensing through the upper canaliculus (Modern ophthalmology. A guide for physicians. Ed. by C. F. Danilichev. - S.-Pb. , 2000. - S. 398-399). However, this method can be applied in case of detection in the wound proximal end of the tubule, and this is not always possible.

The aim of the invention is to increase the effectiveness of treatment, reducing the number of complications, improvement of convenience in the work.

This goal is achieved by the fact that when traumatic separation or rupture of the lower eyelid from the inner spikes of damage to the lower lacrimal canaliculus at PHO we propose to use a blunt cannula for irrigation of the lacrimal ducts.

Comparative analysis of the prototype showed that the proposed solution differs from the prototype in that the pre-expanded lacrimal point insertion cannula with a scaffold inside, then round the scaffold is retrograde through the lacrimal canaliculus, the lacrimal SAC, intact lacrimal canaliculus. Thus, in the lacrimal canaliculus remains blunt cannula with a scaffold inside.

Thus, the proposed method meets the criteria of the invention is moved not only from the prototype, but also on other technical solutions in this and related fields. So the authors have not found analogues of the way PHO gap lacrimal canaliculi when the wounds of the eyelids, in which he used the blunt cannula for irrigation of the lacrimal ducts, namely the use of the cannula allows to achieve good treatment results and to avoid complications.

This method can be used in ophthalmologic hospitals with emergency care.

Thus, the method meets the criteria of "inventive step" and "industrial applicability".

The method is as follows: the wound century produced a consistent extension of conical probes the lower lacrimal punctum, take a blunt cannula (outer diameter of 0.3-0.6 mm) for irrigation of the lacrimal system, enter it from the side of the working end of the line 0.1 mm in diameter, and extend the line so that the line was in the cannula, but was not visible in the area of the working end of the cannula. Then in the extended lower lacrimal point insertion cannula and extend the line towards the medial end of the tubule. Then through the upper lacrimal point put the probe Jones eye on the working end of a type "Poros the soup lacrimal canaliculus or the lacrimal SAC. Then rotate the probe around the handle axis, out through the medial part of the torn bottom of the lacrimal canaliculi into the wound of the lower eyelid. In the eye of the probe input line, one end of which is removed via cannula and the next return stroke of the probe line extending along the inner part of the damaged tubules through a common lacrimal canaliculus or the lacrimal SAC, the upper lacrimal canaliculus and outputting one end through the top of the lacrimal point. The probe is released from the fishing line. Thus, broken lower lacrimal canaliculus link end to end of the cannula, which is located inside a line drawn through the upper and lower lacrimal punctum, the upper and lower lacrimal canaliculi, the lacrimal SAC is round the ends of the fishing line fix with adhesive tape on the skin of the forehead. Then olivem wound century by the generally accepted rules of ophthalmic surgery. Blunt cannula must be in the lower lacrimal canaliculus 5-6 days, if necessary, you can make the introduction of antiseptic solutions in the lacrimal way, the irrigation of the lacrimal ducts, connecting the syringe to the cannula.

Example 1. Vadim Perfiliev, 10 years. Diagnosis at admission: ripped here-bitten, the wound of the lower eyelid with damage to the lower lacrimal canaliculus of the left eye, the wound of the proposed methodology. It was noted smooth postoperative period, achieved good cosmetic and functional results. After 6 months was noted persistent good functionally result, watery eyes have been noted.

Example 2. Shishkin Alyosha, 7 years. Diagnosis at admission: ripped here-bite wounds of the upper and lower eyelids with damage to both the lacrimal tubules of the right eye. On admission the patient in the emergency operating made PHO wounds century and tubules by the proposed method, when this was initially carried out line by means of the probe Jones through the proximal segment of the damaged lower lacrimal canaliculus, then the described method. In this case also was awarded a satisfactory cosmetic and functional result.

This method was used in 6 patients with lesions of the lacrimal tubules in cross-wounds of the eyelids.

Using our method allows to avoid such complications this kind of damage, as stricture of the lower lacrimal canaliculus. When using a blunt cannula for irrigation of the lacrimal ducts made possible the introduction of antiseptic solutions in the lacrimal way, the irrigation of the lacrimal ducts. When necessary ways, after removal of the cannula through almost any period of 1-2 months the cannula may be optionally introduced into the lacrimal point on the line as the guide. In addition, the proposed methodology can be used for PHO upper lacrimal canaliculus in cross-wound of the upper eyelid in the inner third or the margin of the upper eyelid from the inner adhesions. The percentage of complications prototype (according to the literature) is 0.4 to 0.5%). The method allows to increase the effectiveness of the treatment, there is a decrease in bed-days. The method is simple, affordable, feasible.

The primary surgical treatment of the lacrimal canaliculi with injuries century, including the introduction into the lumen of the tubule through the lacrimal point damaged lacrimal canaliculi to the lacrimal SAC of the conductor, the stitching on it is damaged tubules "end to end" and suturing the torn century, characterized in that as a guide use a cannula with an outer diameter of 0.3-0.6 mm, inside which is a monofilament with a diameter of 0.1 mm, moreover, after the introduction of the cannula into the lacrimal point damaged tubules through the lacrimal point intact lacrimal canaliculi enter a spiral probe and display its proximal end through the Department povrejdennogo who W ill result through the lacrimal pathways in the lacrimal point intact tubules round.

 

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