RT tube application method for simultaneously solving blockage of upper and lower lacrimal passages

Abstract

The invention relates to the technical field of RT type lacrimal passage drainage tube application, and particularly discloses an RT tube application method for simultaneously solving upper and lower lacrimal passage blockage, which comprises the following steps of: firstly, performing preoperative local anesthesia on a patient; the upper lacrimal punctum and the lower lacrimal punctum of the diseased eye are expanded, and after a thin probe is used for probing the obstruction position of the lacrimal passage from the upper lacrimal ductule and the lower lacrimal ductule, the lacrimal passage is flushed Expanding the obstructed part of the lacrimal passage by using a large probe; then, the artificial lacrimal duct is implanted, the RT tube is implanted into the upper and lower lacrimal ducts at the same time, the problem of blockage of multiple parts is solved through a single instrument, repeated damage to periorbital tissue caused by fractional operations is avoided, and the device is particularly suitable for complex cases that upper and lower lacrimal canalicules and nasolacrimal ducts are blocked or narrow at the same time; the whole-course drainage of the tears from the upper and lower lacrimal passages to the nasal cavity is further ensured, and the physiological path of tear circulation is recovered; the RT tube is placed, skin or mucous membrane does not need to be cut open, no scar is visible after operation, and the requirement for periocular beauty is met.

Description

Technical Field

[0001] The present invention relates to the technical field of the application of RT-type lacrimal duct drainage tubes, and specifically to an application method of RT tubes for simultaneously solving upper and lower lacrimal duct blockages. Background Technique

[0002] The RT-type lacrimal duct drainage tube belongs to a disposable ophthalmic instrument, which is specifically used for the supportive treatment of lacrimal duct obstructive diseases (such as chronic dacryocystitis, after lacrimal canaliculus rupture), and relieves symptoms by establishing a lacrimal fluid drainage channel. The RT-type lacrimal duct drainage tube is made of high-purity silica gel, has excellent biocompatibility, can avoid allergic reactions, and has the characteristics of softness and durability; furthermore, the RT-type lacrimal duct drainage tube adopts a sterile design to reduce the risk of infection.

[0003] The traditional solutions for upper and lower lacrimal duct blockages mainly include the following several types:

[0004] Conservative treatment: Massage method: Gently press the lacrimal sac area with the pulp of the index finger along the inner canthus towards the nasal wing (3 - 4 times a day, 5 - 10 seconds each time) to promote the flow of lacrimal fluid and push out the obstructing substances. Hot compress method: Apply a warm towel to the eyes for 10 - 15 minutes to dilate the lacrimal duct, promote blood circulation, and relieve inflammation and the accumulation of secretions. Lacrimal duct irrigation method: Inject normal saline into the lacrimal punctum through a syringe to wash the secretions or obstructing substances in the lacrimal duct, which has both diagnostic and therapeutic functions.

[0005] Surgical treatment: Traditional open surgery or endoscopic minimally invasive surgery.

[0006] Drug adjuvant treatment: Such as levofloxacin eye drops to prevent or control lacrimal duct infections.

[0007] Among the above various types of methods, such as conservative treatment, it takes a long time and requires long-term adherence; surgical treatment methods are likely to cause damage to the periocular tissues; drug adjuvant treatment: it is easy to develop drug resistance over time, and the later treatment effect is poor. Therefore, we propose an application method of RT tubes for simultaneously solving upper and lower lacrimal duct blockages. Summary of the Invention

[0008] The purpose of the present invention is to solve the deficiencies in the prior art, and propose an application method of RT tubes for simultaneously solving upper and lower lacrimal duct blockages.

[0009] In order to achieve the above purpose, the present invention adopts the following technical solutions:

[0010] An application method of RT tubes for simultaneously solving upper and lower lacrimal duct blockages includes the following steps:

[0011] Step 1: First, perform preoperative local anesthesia on the patient.

[0012] Step 2: Dilate the upper and lower lacrimal puncta of the affected eye. First, use a thinner probe to probe through the lacrimal passage obstruction from the upper and lower lacrimal ducts, and then rinse the lacrimal passage with normal saline. Then, use a larger probe to dilate the lacrimal passage obstruction;

[0013] Step 3: Insert a lacrimal passage probe with a memory wire into the upper lacrimal duct, and under direct vision of a nasal endoscope, hook out the memory wire inside the probe from the lower duct to the outside of the nasal cavity;

[0014] Step 4: Open the package of the RT-type lacrimal passage drainage tube, apply eye ointment on the outside of the RT-type lacrimal passage drainage tube to lubricate the RT lacrimal passage drainage tube;

[0015] Step 5: Connect the lead wire at the head of the thin tube of the RT-type lacrimal passage drainage tube to the memory wire outside the nasal cavity, and pull up the memory wire so that the thin tube part of the RT-type lacrimal passage drainage tube passes through the lacrimal passage along the path of the memory wire and exits from the upper lacrimal duct.

[0016] Step 6: Insert a lacrimal passage probe with a memory wire into the lower lacrimal duct, hook out the memory wire from inside the nasal cavity, then connect it to another memory wire, and pull this memory wire into the lacrimal passage from the nasal lacrimal duct orifice in the lower nasal meatus until it exits from the lower lacrimal duct.

[0017] Step 7: Pull up the traction wire at the top of the thin tube of the RT tube so that the thick tube part of the RT-type artificial lacrimal tube is placed into the nasolacrimal duct and the lacrimal sac. At this time, pay attention to the sense of falling when the RT tube enters the lacrimal sac;

[0018] Step 8: Connect the traction wire at the top of the thin tube of the RT-type lacrimal passage drainage tube to the memory wire of the lower lacrimal duct, apply eye ointment for lubrication, and pull down this memory wire to fold the thin end of the RT tube back into the lacrimal passage from the lower lacrimal passage until it exits from the lower nasolacrimal duct into the nasal cavity.

[0019] Step 9: Then adjust the position of the thin tube between the upper and lower lacrimal puncta at the inner canthus of the affected side to the midpoint, and then cut off the excess thin tube of the RT lacrimal type drainage tube in the nasal cavity of the affected side, and keep about 1 cm of the lead wire at the tail end of the thick tube and tie a knot, and cut off the excess lead wire for subsequent tube removal.

[0020] Preferably, after applying the eye ointment in Step 3, repeatedly comb the RT lacrimal type drainage tube with fingers so that the eye ointment is evenly distributed on the surface of the RT lacrimal type drainage tube.

[0021] Preferably, the position where the eye ointment is applied to the RT lacrimal type drainage tube in Step 5 is outside the nasal cavity.

[0022] Preferably, during the insertion of the RT lacrimal type drainage tube in Step 7, medical staff assist in gently pushing and inserting the RT lacrimal type drainage tube in the nasal cavity.

[0023] Preferably, the component for applying the eye ointment in Step 8 is the suture of the RT lacrimal type drainage tube.

[0024] Compared with the prior art, the beneficial effects of the present invention are as follows:

[0025] Through the above application method, the present invention uses the RT tube to implant into the upper and lower lacrimal ducts simultaneously, solves the problem of multi-site obstruction with a single instrument, avoids repeated damage to the periocular tissues caused by staged surgeries, and is especially suitable for complex cases of combined stenosis of the upper and lower lacrimal canaliculi and nasolacrimal duct; further ensures the whole-course drainage of tears from the upper and lower lacrimal ducts to the nasal cavity, and restores the physiological path of tear circulation; furthermore, through the placement of the RT tube, there is no need to incise the skin or mucosa, and there are no visible scars after surgery, meeting the aesthetic requirements of the periocular area; it should be noted that: the synchronous dilation of the upper and lower lacrimal ducts by the RT tube can avoid secondary stenosis caused by uneven pressure after the dredging of a single site, and significantly improve the overall patency rate of the lacrimal duct after surgery; secondly, the RT tube is a disposable sterile design to avoid cross-infection of reusable instruments, and the RT tube is made of silicone material with a smooth surface that is not easy to attach microorganisms, suitable for long-term indwelling. In summary, the RT tube realizes the synchronous and efficient treatment of upper and lower lacrimal duct obstruction through the dredging of the whole lacrimal duct, minimally invasive operation and its own material advantages, combines functional recovery and aesthetics, and is the first-line treatment plan for complex lacrimal duct obstruction diseases. Specific embodiments

[0026] Next, in combination with the embodiments of the present invention, the technical solutions in the embodiments of the present invention will be described clearly and completely. Obviously, the described embodiments are only a part of the embodiments of the present invention, rather than all of the embodiments.

[0027] Embodiment 1

[0028] Please refer to the application method of the RT tube for simultaneously solving upper and lower lacrimal duct obstruction, including the following steps:

[0029] Step 1: First, perform preoperative local anesthesia on the patient, specifically infraorbital nerve block anesthesia on the affected side, and surface infiltration anesthesia of the conjunctival sac and the nasal mucosa on the affected side;

[0030] Step 2: Dilate the upper and lower lacrimal puncta of the affected eye. First, use a No. 6 fine probe to probe through the lacrimal duct obstruction from the upper and lower lacrimal canaliculi, and then rinse the lacrimal duct with physiological saline. Then use an 8th or 9th large probe to dilate the lacrimal duct obstruction;

[0031] Step 3: Insert a lacrimal duct probe with a memory wire into the upper lacrimal canaliculus, and under direct vision of a nasal endoscope, hook out the memory wire in the probe from the lower duct to the outside of the nasal cavity;

[0032] Step 4: Open the package of the RT-type lacrimal duct drainage tube, apply eye ointment on the outside of the RT-type lacrimal duct drainage tube, and lubricate the RT lacrimal duct drainage tube;

[0033] Step 5: Connect the lead wire at the head of the thin tube of the RT type lacrimal duct drainage tube to the memory wire outside the nasal cavity, and pull up the memory wire so that the thin tube part of the RT type lacrimal duct drainage tube passes through the lacrimal duct along the path of the memory wire and exits from the upper lacrimal canaliculus.

[0034] Step 6: Insert a lacrimal duct probe with a memory wire into the lower lacrimal canaliculus, hook out the memory wire from the nasal cavity, then connect it to another memory wire, and pull this memory wire into the lacrimal duct from the nasolacrimal duct orifice in the lower nasal meatus until it exits from the lower lacrimal canaliculus.

[0035] Step 7: Pull up the traction wire at the top of the thin tube of the RT tube so that the thick tube part of the RT type artificial lacrimal tube is inserted into the nasolacrimal duct and the lacrimal sac. At this time, pay attention to the sense of falling when the RT tube enters the lacrimal sac;

[0036] Step 8: Connect the traction wire at the top of the thin tube of the RT type lacrimal duct drainage tube to the memory wire of the lower lacrimal canaliculus, apply eye ointment for lubrication, pull down this memory wire, and fold the thin end of the RT tube back into the lacrimal duct from the lower lacrimal duct until it exits from the lower nasolacrimal duct into the nasal cavity.

[0037] Step 9: Then adjust the position of the thin tube between the upper and lower lacrimal puncta at the inner canthus of the affected side to the midpoint, and then cut off the excess thin tube of the RT type lacrimal drainage tube in the nasal cavity of the affected side. Keep about 1 cm of the lead wire at the tail end of the thick tube and tie a knot, and cut off the excess lead wire for subsequent removal of the tube.

[0038] As a technical optimization scheme of the present invention, after applying the eye ointment in Step 3, repeatedly comb the RT type lacrimal drainage tube with fingers so that the eye ointment is evenly distributed on the surface of the RT type lacrimal drainage tube.

[0039] As a technical optimization scheme of the present invention, the position where the eye ointment is applied to the RT type lacrimal drainage tube in Step 5 is outside the nasal cavity.

[0040] As a technical optimization scheme of the present invention, during the insertion of the RT type lacrimal drainage tube in Step 7, medical staff assist in gently pushing and inserting the RT type lacrimal drainage tube in the nasal cavity.

[0041] As a technical optimization scheme of the present invention, the component for applying the eye ointment in Step 8 is the suture of the RT type lacrimal drainage tube.

[0042] Example 2

[0043] Comparison table of solutions for various types of lacrimal duct obstruction

[0044]

[0045]

[0046] Success rate: Short term refers to 3 - 6 months after treatment, and long term refers to the follow-up results over 1 year.

[0047] In this embodiment, it can be known that compared with other types of solutions for lacrimal duct obstruction, the RT tube application technique has obvious advantages in terms of success rate and gray scale time. This technology has the application advantages of precision and non-invasiveness, and the diagnosis and treatment cost is relatively low, showing significant advantages in application.

[0048] Example 3

[0049] Subject selection: A total of 206 patients (215 eyes) diagnosed with lacrimal duct obstruction and chronic dacryocystitis (mainly soft tissue obstruction) from January 2018 to October 2024 were collected. Among them, there were 43 males (43 eyes) and 163 females (172 eyes), aged 29 - 89 years. Before surgery, lacrimal duct probing and endoscopic examination were performed to exclude false passages. During the operation, a new type of RT lacrimal duct drainage tube was used.

[0050] The criteria for prognosis judgment are as follows:

[0051] Cured: After extubation, there is no epiphora, no purulent secretion overflows when pressing the lacrimal sac area, and the lacrimal duct is patent after irrigation.

[0052] Improved: Occasionally there is epiphora, no purulent secretion overflows when pressing the lacrimal sac area, the lacrimal duct is patent but not smooth after irrigation,

[0053] and there is partial reflux.

[0054] Not cured: There is epiphora after extubation, and the lacrimal duct is not patent after irrigation.

[0055] Postoperative efficacy:

[0056] Extubation time: 1 - 6 months (average 3.0 ± 2.79 months)

[0057] Follow-up time: 12 - 60 months (average 36.0 ± 24.0 months)

[0058] Among them: 108 eyes (50.23%) were cured, 68 eyes (31.62%) were improved, and 39 eyes (18.14%) were ineffective. The effective rate was 81.85%.

[0059] Complications: There was no obvious nasal bleeding during the operation. After the operation, some patients had nasal congestion symptoms. There were 3 cases of prolapse of the upper lacrimal duct, 11 cases of different degrees of laceration of the lacrimal punctum, and 3 cases of granulation tissue hyperplasia at the lacrimal punctum.

[0060] Based on this embodiment, it can be known that the RT tube application technique can obtain relatively ideal prognosis effects in practical applications, and its effective intervention efficiency reaches 81.86%.

[0061] In the actual application of this technology, first, block and anesthetize the infraorbital nerve on the affected side, and perform surface infiltration anesthesia on the conjunctival sac and the nasal mucosa on the affected side; dilate the upper and lower lacrimal puncta of the affected eye. First, use a No. 6 fine probe to probe and unblock the lacrimal passage obstruction from the upper and lower lacrimal ducts, and then rinse the lacrimal passage with normal saline. Then use an 8th or 9th large probe to dilate the lacrimal passage obstruction;

[0062] As a preferred solution for actual application, lidocaine and oxybuprocaine (Benoxil) are selected as the anesthetic here. Clinical feedback shows that most patients can have no obvious pain;

[0063] Insert a lacrimal passage probe with a memory wire into the upper lacrimal duct, and under direct vision with a nasal endoscope, hook out the memory wire inside the probe from the lower duct to the outside of the nasal cavity; in actual operation, after clearly seeing the positions reached by the probe and the guide wire under direct vision with the nasal endoscope, then hook out the guide wire to avoid blindly operating and damaging the nasal mucosa, causing obvious bleeding;

[0064] Open the package of the RT tear-shaped drainage tube, and apply eye ointment on the outside of the RT tear-shaped drainage tube. Pull up the traction wire at the top of the thin tube of the RT tube to insert the thick tube part of the RT artificial tear duct into the nasolacrimal duct and the lacrimal sac. At this time, pay attention to the sense of falling when the RT tube enters the lacrimal sac;

[0065] Insert a lacrimal passage probe with a memory wire into the lower lacrimal duct, hook out the memory wire from the nasal cavity, then connect it to another memory wire, and pull this memory wire from the nasal orifice of the nasolacrimal duct in the lower nasal passage into the lacrimal passage until it exits from the lower lacrimal duct.

[0066] Connect the traction wire at the top of the thin tube of the RT-type lacrimal passage drainage tube to the memory wire of the lower lacrimal duct, apply eye ointment for lubrication, pull down this memory wire, and fold the thin end of the RT tube back into the lacrimal passage from the lower lacrimal passage until it exits the nasal cavity from the lower nasolacrimal duct. Then adjust the position of the thin tube between the upper and lower lacrimal puncta at the medial canthus of the affected side to the midpoint, and then cut off the excess thin tube of the RT tear-shaped drainage tube in the nasal cavity on the affected side, and leave about 1 cm of the lead wire at the end of the thick tube and tie a knot, and cut off the excess lead wire for subsequent tube removal.

[0067] The above is only a preferred specific implementation manner of the present invention, but the protection scope of the present invention is not limited thereto. Any person skilled in the art within the technical scope disclosed by the present invention, according to the technical solution and inventive concept of the present invention, makes equivalent replacements or changes, and all should be covered within the protection scope of the present invention.

Claims

1. Application method of RT type lacrimal duct drainage tube for simultaneously solving upper and lower lacrimal duct obstruction, characterized in that, It includes the following steps: Step 1: First, perform preoperative local anesthesia on the patient. Step 2: Dilate the upper and lower lacrimal puncta of the affected eye. First, use a thinner probe to probe through the lacrimal duct obstruction from the upper and lower lacrimal ducts, and then rinse the lacrimal duct with normal saline. Then use a larger probe to dilate the lacrimal duct obstruction. Step 3: Insert a lacrimal duct probe with a memory wire into the upper lacrimal duct, and under direct vision of the nasal endoscope, hook out the memory wire inside the probe from the lower duct to the outside of the nasal cavity. Step 4: Open the package of the RT type lacrimal duct drainage tube, apply eye ointment on the outside of the RT type lacrimal duct drainage tube to lubricate the RT lacrimal duct drainage tube. Step 5: Connect the lead wire at the head of the thin tube of the RT type lacrimal duct drainage tube to the memory wire outside the nasal cavity, and pull up the memory wire so that the thin tube part of the RT type lacrimal duct drainage tube passes through the lacrimal duct along the path of the memory wire and exits from the upper lacrimal duct. Step 6: Insert a lacrimal duct probe with a memory wire into the lower lacrimal duct, hook out the memory wire from the nasal cavity, then connect it to another memory wire, and pull this memory wire from the nasal orifice of the nasolacrimal duct in the lower nasal passage into the lacrimal duct and exit from the lower lacrimal duct. Step 7: Pull up the traction wire at the top of the thin tube of the RT tube so that the thick tube part of the RT type artificial lacrimal duct is placed into the nasolacrimal duct and lacrimal sac. At this time, pay attention to the sense of falling when the RT tube enters the lacrimal sac. Step 8: Connect the traction wire at the top of the thin tube of the RT type lacrimal duct drainage tube to the memory wire of the lower lacrimal duct, apply eye ointment for lubrication, and pull down this memory wire to fold the thin end of the RT tube back into the lacrimal duct from the lower lacrimal duct and exit from the lower nasolacrimal duct to the nasal cavity. Step 9: Then adjust the position of the thin tube between the upper and lower lacrimal puncta at the medial canthus of the affected side to the midpoint, and then cut the redundant thin tube part of the thin tube of the RT type lacrimal drainage tube in the nasal cavity of the affected side, and leave about 1 cm of the lead wire at the tail end of the thick tube and tie a knot, and cut off the redundant lead wire for subsequent removal of the tube.

2. The application method of the RT tube for simultaneously solving the blockage of the upper and lower lacrimal ducts according to claim 1, characterized in that: After applying the eye ointment in Step 3, repeatedly comb the RT type lacrimal drainage tube with fingers so that the eye ointment is evenly distributed on the surface of the RT type lacrimal drainage tube.

3. The application method of the RT tube for simultaneously solving the blockage of the upper and lower lacrimal ducts according to claim 1, characterized in that: The position where the eye ointment is applied to the RT type lacrimal drainage tube in Step 5 is outside the nasal cavity.

4. The application method of the RT tube for simultaneously solving the blockages of the upper and lower lacrimal ducts according to claim 1, characterized in that: In Step 7, during the insertion process of the RT type lacrimal drainage tube, medical staff gently assist in pushing and inserting the RT type lacrimal drainage tube in the nasal cavity.

5. The application method of the RT tube for simultaneously solving the blockages of the upper and lower lacrimal ducts according to claim 1, characterized in that: The component for applying eye ointment in Step 8 is the suture of the RT type lacrimal drainage tube.

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