替吉奥致严重泪道阻塞的临床病例分析

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目的:探讨替吉奥(S-1)引起严重泪道阻塞患者的临床特征、治疗及预后。方法:对2017年1月至2019年1月在解放军总医院第三医学中心眼科泪器病中心住院手术治疗的S-1相关严重泪道阻塞患者临床及随访资料进行回顾性分析。结果:共有12例患者纳入本研究,男性7例,女性5例,年龄(53±8)岁;口服S-1时间为(4.1±1.1)个月,从开始服用S-1至溢泪症状出现的时间为(53.3±31.2)d。12例患者均为双眼患病(12例,24眼),同时出现上下泪小管阻塞(12例,24眼,48个泪小管),其中45个泪小管(93.8%)重度阻塞,3个泪小管(6.2%)中度阻塞。2例患者双眼上下泪小管的泪点(8个)完全闭锁。12例患者中8例双眼(16眼)同时并发鼻泪管完全阻塞,4例患者双眼(8眼)同时并发鼻泪管不完全阻塞。8例患者接受泪道内窥镜下泪道激光成形术联合双泪小管置入式人工泪管置入术,取管后5例溢泪减轻,3例无好转。2例接受泪囊切开逆行探查疏通泪小管联合双泪小管置入式人工泪管置入术,取管后溢泪减轻。2例接受泪囊切开逆行探查疏通泪小管联合泪囊鼻腔吻合术及双泪小管置入式人工泪管置入术,取管后溢泪症状改善明显,仅有轻度溢泪。结论:S-1所致严重泪道阻塞以广泛性多部位阻塞为特征,选择合适的手术治疗,部分患者溢泪症状好转。“,”Objective:To explore the clinical characteristics, treatment and prognosis of patients with severe lacrimal duct obstruction caused by tegafur-gimeracil-oteracil potassium (S-1).Methods:The medical records and follow-up data of the surgical inpatients with severe lacrimal duct obstruction caused by S-1 in Lacrimal Center of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital from January 2017 to January 2019 were analyzed retrospectively.Results:A total of 12 patients were enrolled in this study, including 7 males and 5 females, aged (53±8) years. The time of oral administration of S-1 was (4.1±1.1) months, and the time from the beginning of administration of S-1 to the onset of epiphora symptoms was (53.3±31.2) days. All the 12 patients had binocular diseases (involving 12 cases, 24 eyes) and obstruction of both upper and lower lacrimal canaliculi (involving 48 lacrimal canaliculi). Among the 48 obstructed lacrimal canaliculi, 45 (93.8%) were severe, and 3 (6.2%) were moderate. The 8 lacrimal points of the upper and lower lacrimal canaliculi in both eyes of the 2 patients were completely atresic. In 12 patients, 16 eyes in 8 patients were complicated with complete obstruction of nasolacrimal ducts and 8 eyes in the other 4 patients were complicated with incomplete obstruction of nasolacrimal ducts. Eight patients underwent laser dacryoplasty combined with bicanalicular intubation assisted by lacrimal canaliculus micro-endoscopy. After taking off the tubes, epiphora was relieved in 5 patients but not improved in the other 3 patients. Two patients underwent retrograde exploration to probe canaliculi transdacryocyst combined with bicanalicular intubation. After taking off the tubes, epiphora was relieved. Two patients underwent retrograde exploration to probe canaliculi transdacryocyst combined with dacryocystorhinostomy. After taking off the tubes, epiphora was improved obviously and only slight epiphora was found.Conclusions:Severe lacrimal duct obstruction caused by S-1 was characterized by extensive multiple obstruction. Appropriate surgical treatment can improve the symptoms of epiphora in some patients.
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