目的：观察胰蛋白酶在Nd：YAG激光泪道成形术后进行泪道冲洗治疗泪道阻塞的疗效和安全性。

方法：回顾性研究，纳入于本院接受Nd：YAG激光泪道成形术的泪道阻塞患者160例160眼。根据术后冲洗方案的不同将患者分为两组：试验组(术后4 wk内，使用25%胰蛋白酶溶液进行泪道冲洗，1次/周)和对照组(接受生理盐水冲洗)； 通过查阅病历记录，收集患者基线资料、手术记录、术后冲洗记录、以及术后1、2、4、6 mo的随访结果。

结果：两组患者一般资料具有可比性。术后1 mo试验组的起效率为90.0%，对照组为71.3%，试验组的起效率显著高于对照组(P<0.05)。两组患者术前泪道阻塞眼的泪河高度均高于健眼(均P<0.01)，术后1 mo泪道阻塞眼泪河高度低于术前(均P<0.01)。试验组的泪道阻塞眼术后泪河高度低于对照组(P<0.01)。术后2、4、6 mo，试验组泪道阻塞的复发率分别为1.4%、6.9%、5.6%，对照组分别为5.3%、17.5%、12.3%。试验组总复发率(13.9%)相较对照组(35.1%)明显降低(P<0.05)。试验组和对照组术后均无严重并发症发生，且试验组较对照组对治疗结果具有更高的满意度(P<0.01)。

结论：胰蛋白酶在Nd：YAG激光泪道成形术后进行泪道冲洗治疗泪道阻塞，具有更好的起效率和相对较低的复发率，在泪道阻塞激光治疗术后成功率和降低复发率中具有较好的应用前景。

METHODS:This retrospective cohort study included 160 patients(160 eyes)with lacrimal duct obstruction who underwent Nd:YAG laser dacryocystoplasty at our institution. Based on the postoperative irrigation protocol, patients were allocated into two groups: the experimental group, which received lacrimal irrigation with a 25% trypsin solution once weekly for 4 wk postoperatively, and the control group, which received irrigation with normal saline on the same schedule. Patient data was obtained by reviewing electronic medical records, including baseline characteristics, surgical records, postoperative irrigation protocols, and follow-up outcomes at 1, 2, 4, and 6 mo post-surgery.

RESULTS:The baseline characteristics were comparable between the two groups. At 1 mo postoperatively, the success rate in the experimental group was 90.0%, significantly higher than 71.3% in the control group(P<0.05). Preoperatively, the tear meniscus height in obstructed eyes was higher than in healthy eyes in all patients(all P<0.01). At 1 mo postoperatively, the tear meniscus height in obstructed eyes decreased significantly compared to preoperative levels(all P<0.01), and was lower in the experimental group than in the control group(P<0.01). The recurrence rates of obstruction at 2, 4, and 6 mo were 1.4%, 6.9%, and 5.6% in the experimental group, compared to 5.3%, 17.5%, and 12.3% in the control group, respectively. The total recurrence rate was significantly lower in the experimental group(13.9%)than in the control group(35.1%; P<0.05). No severe complications occurred in either group. Patient satisfaction with the treatment outcome was significantly higher in the experimental group than in the control group(P<0.01).

CONCLUSION:Lacrimal irrigation with trypsin following Nd:YAG laser dacryocystoplasty demonstrates superior efficacy and a lower recurrence rate in the treatment of lacrimal duct obstruction. Trypsin shows promising application prospects for improving surgical success rate and reducing recurrence rate after laser treatment for lacrimal duct obstruction.