涙道内視鏡下でのヌンチャク型シリコーンチューブ挿入術の手術成績

Outcome of endoscope-guided insertion of nunchaku-type silicone tube

要約　目的：内視鏡下でのヌンチャク型シリコーンチューブ（NST）挿入術の手術成績の報告。対象と方法：総涙小管閉塞があり，流涙症がある患者36例39側（男性7例，女性29例，平均年齢71歳）を対象とした。涙道内視鏡を使用して，閉塞部の穿破とNSTの挿入を行い，約2か月後に抜去した。結果：29側（手術完了率：74％）にNSTを挿入でき，10側は穿破できず手術を中止した。29側全例が通水可能になり，自覚症状が改善した（成功率100％）。涙道内視鏡所見から，閉塞所見は膜状閉塞，管状閉塞，涙囊虚脱に大別できた。結論：涙道内視鏡所見を理解することにより，NST挿入術の完了率，すなわち成功率が向上すると考えられた。

Abstract.　Purpose：To report the rate of success and outcome of endoscope-guided insertion of nunchaku-type silicone tube for obstructed lacrimal passage. Cases and Method：This retrospective study was made on 39 eyes of 36 patients who underwent surgery during a 13-month period. The series comprised 7 male and 29 female eyes. A lacrimal endoscope was used to facilitate perforation and insertion of silicone tube. When successfully inserted,the silicone tube was removed 2 months later. Result：The silicone tube could be inserted in 29 eyes（74％）. Surgery had to be discontinued in the other 10 eyes（26％）. Passage of tear fluid remained permanent in all the 29 eyes. By endoscopic observation,the obstructed lacrimal passage was classified into 3 groups：membranous type,tubular type,and collapsed lacrimal sac. Conclusion：Adjunct use of lacrimal endoscope facilitates insertion of nunchaku-type silicone tube.