目的：探讨鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞的有效性和安全性，指导临床应用。

方法：回顾性系列病例研究。选取2016-09/2019-09在我院就诊的泪道探通无效的先天性鼻泪管阻塞患儿158例158眼作为研究对象，患儿均行鼻内镜辅助RS泪道插管术治疗。术后1、3、6mo定期随访。观察患儿性别、年龄、既往泪道探通次数、术前泪道有无分泌物、治疗效果、并发症、鼻泪管阻塞类型。对年龄、探通次数与手术有效率之间的关系做Spearman秩相关系数计算与分析，对不同类型鼻泪管阻塞的手术有效率采用Fisher确切概率法检验，对有无脓性分泌物的手术有效率做χ²检验。

结果：总手术有效率为89.9%(142/158)。手术有效率随着年龄增长呈下降的趋势(r_s=-1.000，P<0.01)。手术有效率随着泪道探通次数增多呈下降的趋势(r_s=-1.000，P<0.01)。膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞(P<0.05)。有无脓性分泌物两种症状的手术有效率无差异(P>0.05)。主要并发症有：假道16眼(10.1%)、泪道引流管提前脱出14眼(8.9%)、眼红、刺激性溢泪18眼(11.4%)、上下泪点对合黏连3眼(1.9%)、泪点肉芽肿1眼(0.6%)。

结论：鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞有较高有效率，较好的安全性。手术有效率随着年龄增长而下降，随着泪道探通次数增多而下降，膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞。

METHODS: Retrospective case series. Totally 158 children(158 eyes)with congenital nasolacrimal duct obstruction who were failed probing in our hospital from September 2016 to September 2019 were selected as the research subjects. All patients underwent endoscopic-assisted RS silicone intubation. Regular follow-up was performed 1, 3, and 6mo after surgery. Observe the children's gender, age, treatment history, presence or absence of discharge before surgery; treatment effect; complications; types of nasolacrimal duct obstruction. Spearman's correlation coefficient calculation and analysis of the relationship between ages, times of probing and operation efficiency, Fisher's exact probability test for the operation efficiency of different types of nasolacrimal duct obstruction, and chi square test for the operation efficiency of presence or absence of discharge.

RESULTS: The total effective rate was 89.9%(142/158). The effective rate of surgery tends to decrease with age(Spearman's correlation coefficient r_s= -1.000, P<0.01). The effective rate of surgery showed a downward trend with the increase of the times of probing(Spearman's correlation coefficient r_s= -1.000, P<0.01). The efficiency of membranous nasolacrimal duct obstruction surgery is higher than that of complex nasolacrimal duct obstruction, and the difference is statistically significant(P<0.05). It cannot be considered that there is a statistically significant difference in the effectiveness of the operation between the two symptoms with or without discharge(P>0.05). The main complications were: false passage formation(16 eyes, 10.1%), loss of tube(14 eyes, 8.9%), red eyes and irritated tears(18 eyes, 11.4%), punctums tissue adhesion(3 eyes, 1.9%), punctum granuloma formation(1 eye, 0.6%).

CONCLUSION: Endoscopic-assisted RS silicone intubation has a higher effective rate and better safety in the treatment of congenital nasolacrimal duct obstruction after failed probing in children. The effective rate of surgery decreases with age, and decreases with the increase of the times of probing. Membranous nasolacrimal duct obstruction is more effective than complicated nasolacrimal duct obstruction.