目的：评价丝线牵引置管在RS泪道置管术中硅胶管侧穿后的临床应用与安全性。

方法：回顾性分析2022年7月至2025年6月常州市第二人民医院眼科收治的RS 泪道置管术中因硅胶管侧穿后无法常规置管患者的临床资料。所有患者均采用张氏带记忆导丝泪道探通导引针重建生理泪道-鼻腔通路，3-0丝线牵引完成破损硅胶管复位置入，术后至少规范随访6 mo。观察患者术中及术后情况。

结果： 本研究共纳入患者21例21眼，其中男6例，女15例，平均年龄59.6±10.8岁。21 眼术中置管复位成功率为100%。其中3眼硅胶管置入后要求立即取出(1眼因角膜鼻侧溃疡灶形成，需优先治疗眼部感染； 2眼因术眼溢泪不适难以耐受，强烈要求取出)，余18眼硅胶管留置期间均未出现再次脱出、移位等情况，均按计划留置3 mo后顺利拔管。成功植入硅胶管后1、3、6 mo完全通畅率依次为 95%(20眼)、90%(19眼)、81%(17眼)。术后6 mo泪道完全通畅 17 眼(81%)，通而不畅 3 眼(14%)，完全阻塞1眼(5%)。术后并发症包括轻度泪点撕裂2眼、泪点肉芽增生1眼、泪点轻度外翻1眼。3眼立即取出硅胶管的患者中，仅1眼术后3 wk复发泪道阻塞，经再次插管治疗后有效； 其余2眼均治愈，未出现角膜溃疡加重、泪道狭窄及泪道不通等情况。

结论：丝线牵引置管术是RS泪道置管术中硅胶管侧穿后安全、高效的微创补救方案，其具有定位精准、操作高效、组织损伤小等优势，可显著提高硅胶管复位与置管成功率，且并发症可控。

METHODS: A retrospective analysis was conducted on patients with silicone stent perforation and failed conventional RS intubation treated at the Department of Ophthalmology, the Second People's Hospital of Changzhou from July 2022 to June 2025. All patients underwent reconstruction of the physiological lacrimal-nasal passage using Zhang's memory guidewire lacrimal probing and guiding needle. Repositioning and implantation of the damaged silicone stent were completed via 3-0 silk thread traction. Standard follow-up was performed for at least 6 mo postoperatively. Intraoperative and postoperative conditions of the patients were observed.

RESULTS: A total of 21 patients(21 eyes)were enrolled in this study, including 6 males and 15 females, with a mean age of 59.6±10.8 y. The intraoperative salvage intubation success rate was 100% for all 21 eyes. Among them, 3 eyes required immediate removal of the silicone stent after implantation(1 eye developed a nasal corneal ulcer requiring priority treatment of ocular infection; 2 eyes had intolerable epiphora and discomfort and requested stent removal voluntarily). The remaining 18 eyes had no re-displacement or stent prolapse during indwelling, and the stents were successfully extracted after 3 mo of indwelling as scheduled. The complete lacrimal patency rates at 1, 3 and 6 mo after successful silicone stent implantation were 95%(20 eyes), 90%(19 eyes)and 81%(17 eyes), respectively. At 6 mo postoperatively, 17 eyes(81%)presented complete lacrimal passage patency, 3 eyes(14%)showed incomplete lacrimal patency, and 1 eye(5%)had complete obstruction. Postoperative complications included mild lacrimal puncta tearing in 2 eyes, lacrimal puncta granulation hyperplasia in 1 eye, and lacrimal puncta eversion in 1 eye. Among the 3 eyes with immediate silicone stent removal, only 1 eye developed recurrent lacrimal passage obstruction at 3 wk postoperatively, which was effectively treated by re-intubation. The remaining 2 eyes were cured without aggravation of corneal ulcer, lacrimal stenosis, or persistent lacrimal obstruction.

CONCLUSION: The silk thread traction intubation represents a safe, efficient and minimally invasive salvage approach for stent perforation during RS lacrimal intubation. With the advantages of precise localization, high operative efficiency and minimal tissue damage, it greatly increases the success rate of silicone stent repositioning and reintubation accompanied by manageable complications.