3歳未満の小児の涙道閉塞における閉塞部位と治療成績の検討

Examination of obstruction location and treatment outcomes for lacrimal duct obstruction in children aged ＜3 years

要約　目的：国立病院機構名古屋医療センター眼科（以下，当院）に紹介された3歳未満の小児の涙道閉塞について，治療法および治療成績を，年齢や閉塞部位と合わせて検討する。

対象と方法：涙道閉塞による流涙症で当院へ紹介された3歳未満の小児112例130側を対象とした。涙点閉塞の症例を除き原則的に月齢6か月以上の症例に盲目的プロービング（以下，プロービング），必要に応じて全身麻酔下での涙道内視鏡下涙管チューブ挿入を施行し，月齢6か月未満の症例は経過観察とした。

結果：平均月齢は12.1±6.8か月で，月齢6か月未満は10例14側，6か月以上は102例116側であった。月齢6か月以上の閉塞部位は先天性鼻涙管閉塞106側，涙囊下部閉塞5側，涙点閉塞1側で，4側はプロービングを行わず治癒したため閉塞部位は不明であった。月齢6か月以上の先天鼻涙管閉塞のうち全例が初回または2回目のプロービングで治癒し，涙囊下部閉塞の3例4側は2回のプロービングで治癒した。涙囊下部閉塞の1例1側と涙点閉塞の1例1側，体動の制御が困難であった1例1側はいずれも全身麻酔下での涙道内視鏡下涙管チューブ挿入を行い治癒した。初診時に月齢6か月未満，もしくは月齢6か月以上でも経過観察を選択した19側中10側は自然治癒し，9側はその後のプロービングで治癒した。

結論：3歳未満の先天鼻涙管閉塞は外来でのプロービングが有効であり，先天鼻涙管閉塞以外の非典型例では全身麻酔下での涙道内視鏡下涙管チューブ挿入が有効であった。

Abstract　Purpose：To evaluate the treatment methods and outcomes for lacrimal duct obstruction（LDO） in children aged ＜3 years who were referred to our hospital, considering age and obstruction location.

Subjects and Methods：We included 112 children（130 sides） aged ＜3 years who were referred to our hospital for lacrimation due to LDO. Excluding cases of punctal obstruction（PO）, probing was performed in children aged ＞6 months with endoscopic lacrimal duct tube insertion under general anesthesia as needed. Children aged ＜6 months received conservative management.

Results：Of the 112 children, 10（14 sides） and 102（116 sides） were aged ＜6 and ≥6 months, respectively. Their mean age was 12.1±6.8 months. Among children aged ≥6 months, obstruction sites were congenital nasolacrimal duct obstruction（CNLDO） in 106 sides, the lower part of dacryocyst obstruction（DO） in five, and PO in one. The obstruction site was unknown for four sides because probing was not performed, and healing occurred. All cases of CNLDO in children aged ≥6 months resolved after the first or second probing. Among the three cases（four sides） of the lower part of DO, all resolved after two probing procedures were performed. One unilateral case of the lower part of DO, one of the PO, and one unilateral case with difficult body movement control were successfully treated using endoscopic lacrimal duct tube insertion under general anesthesia. Of the 19 sides for which observation was chosen at the initial visit-either in children aged ＜6 or ＞6 months-10 healed spontaneously, and nine healed during subsequent probing.

Conclusion：Outpatient probing is effective for CNLDO in children aged ＜3 years. For atypical cases other than CNLDO, endoscopic nasolacrimal duct tube insertion under general anesthesia is an effective option.