鼻涙管閉塞症の第一選択治療

A therapeutic modality as the first choice for acquired nasolacrimal duct obstruction

　涙道内視鏡のプローブをブジーのように用いて，鼻涙管の閉塞部をモニターで見ながら正確に穿破すれば，鼻涙管閉塞症に対する涙管チューブ挿入術の治療成績の向上が期待できる。今回，慢性涙膿炎を含む鼻涙管閉塞症47例に対して施行した涙管チューブ挿入術において，閉塞部穿破をブジーで行った治療群21例と涙道内視鏡で行った治療群26例とに分け，その術後経過を比較した。その結果，ブジーでは52％の成功率しかなかったのに対し，涙道内視鏡では81％の成功率で有意に成績の向上がみられた（p＝0.04，χ²テスト）。涙管チューブ挿入術は外来で施行できて侵襲が小さい。涙道内視鏡を用いることで治療成績も向上し，鼻涙管閉塞症の第一選択治療法として考えてよい。

Use of a rigid endoscope consisting of a fiberoptic bundle would allow visualization of obstructed site in the nasolacrimal duct on a TV monitor. The efficacy of this endoscope was evaluated on 47 eyes of acquired nasolacrimal duct obstruction treated by bicanalicular silicone intubation. Intubation after classical probing was performed on 21 eyes. The other 26 eyes were intubated under observation by the endoscope. Lasting patency of nasolacrimal duct was obtained in 11 out of 21 Eyes（52％）in the former group and in 21 out of 26 eyes（81％）in the latter. The difference was significant（p＝0.04）. Silicone intubation can be performed on an outpatient basis. Adjunct use of the endoscope is recommended as the first choice in the treatment of acquired nasolacrimal duct obstruction.