涙囊鼻腔吻合術の手術適応と成績

Indications and outcome of dacryocystorhinostomy

　過去7年6か月間に涙囊鼻腔吻合術を行った282例を検索した。年齢は16～91歳，平均65歳であり，男性67例，女性215例であった。術式は鼻外法が72例，鼻内法が210例であり，後者が増加する傾向があった。成功率と手術時間では，鼻内法が優れていた。過去30か月間の鼻内法174例では，閉塞部位は涙囊下部から骨性鼻涙管移行部が最も多く，鼻中隔彎曲症が多かったが，手術には支障がない例が多かった。涙囊鼻腔吻合術では，鼻外法と鼻内法それぞれの特性を生かして手術適応を決める必要がある。

We reviewed 282 cases that received dacryocystorhinostomy during the past 7 years 6months. The series comprised 67males and 215 females. Their ages ranged from 16 to 91 years,average 65 years. Surgery was performed extranasally in 72 cases and endonasally in 210 cases. There was a tendency for the latter to increase in recent years. Endonasal approach was superior regarding the rate of success and duration of surgery. In 174 cases operated during the past 30months,the stenosis was most frequently located between the lower portion of lacrimal sac and the intraosseous part of nasolacrimal duct. There was a high incidence of deflected nasal septum but it did not interfere with the surgery. We advocate to determine the indication for dacryocystorhiostomy after due evaluation of extra-and endonasal approaches.