目的：分析Nd：YAG激光泪道成形术联合泪道支架置入治疗泪道阻塞的疗效及影响因素。

方法：选取2017-06/2019-06期间我院收治的泪道阻塞患者150例150眼，均使用Nd：YAG激光泪道成形术联合泪道支架置入治疗。拔管后随访6mo，根据临床疗效将患者分为有效组(135例135眼)和无效组(15例15眼)，收集一般资料、合并症、泪道阻塞原因、术后泪道冲洗频率及骨性泪道情况等临床资料，分析影响治疗疗效的相关因素。

结果：拔管后随访6mo，本研究纳入患者治疗有效率和复发率分别为90.0%和1.3%。有效组患者的病程显著短于无效组，合并症发生率显著低于无效组，骨性泪道阻塞处长度显著短于无效组，阻塞处最小直径显著长于无效组，且两组患者术后泪道冲洗频率有明显差异(均P<0.05)。Logistic回归分析显示，病程(OR=4.600，95%CI 3.448～6.136)、伴随合并症(OR=2.524，95%CI 1.481～4.302)、骨性泪道阻塞长度(OR=3.785，95%CI 1.844～7.770)和阻塞处最小直径(OR=2.330，95%CI 1.464～3.708)以及术后泪道冲洗频率(OR=4.773，95%CI 2.227～10.231)均是影响Nd：YAG激光泪道成形术联合泪道支架置入治疗疗效的相关因素。

结论：Nd：YAG激光泪道成形术联合泪道支架置入治疗泪道阻塞疗效显著，且并发症发生率和复发率低。病程、合并症、术后泪道冲洗频率、骨性泪道情况均是疗效的影响因素，其中适当提高泪道扩张冲洗次数可提高有效率。

METHODS: Totally 150 eyes of 150 patients with lacrimal duct obstruction admitted to our hospital from June 2017 to June 2019 were selected and treated with Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent placement. Follow-up 6mo after extubation, the patients were divided into effective group(135 cases, 135 eyes)and ineffective group(15 cases, 15 eyes)according to the clinical efficacy. General information, complications, causes of lacrimal duct blockage, postoperative lacrimal duct flushing frequency and clinical data such as the condition of bony lacrimal duct, analysis of related factors affecting the therapeutic effect.

RESULTS: Follow-up 6mo after extubation, the effective rate and recurrence rate were 90.0%(135 eyes)and 1.3%(2 eyes)respectively. The course of the disease in the effective group was significantly shorter than that of the ineffective group, and the incidence of complications was significantly lower than in the ineffective group, the length of osseous lacrimal duct obstruction was significantly shorter than that of the ineffective group, the minimum diameter of the obstruction was significantly longer than that of the ineffective group, there was a significant difference in the frequency of tract flushing(all P<0.05). Logistic regression analysis showed that the course of disease(OR=4.600; 95%CI: 3.448-6.136), complications(OR=2.524; 95% CI: 1.481-4.302),the length of osseous lacrimal duct obstruction(OR=3.785; 95% CI: 1.844-7.770)and the minimum diameter of the obstruction(OR=2.330; 95% CI 1.464-3.708), as well as flushing frequency(OR=4.773; 95% CI: 2.227-10.231)were related factors affecting the therapeutic effect of Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent implantation.

CONCLUSION: Nd:YAG laser lacrimal duct angioplasty combined with lacrimal duct stent implantation is effective in the treatment of lacrimal duct obstruction, with the lower incidence of complications and recurrence rate. The course of disease, complications, postoperative lacrimal passage irrigation frequency and the condition of bone lacrimal passage are all influencing factors, among which the effective rate can be improved by properly increasing the number of lacrimal duct expansion irrigation.