鼻涙管完全閉塞に対するチューブ挿入術の検討

Review of silicone intubation for total nasolacrimal duct obstruction

要約　目的：鼻涙管完全閉塞の症例に，涙道内視鏡下チューブ挿入術を行った成績の報告。対象と方法：過去11か月間に涙道内視鏡下チューブ挿入術を行った鼻涙管完全閉塞の17例19側を対象とした。涙道洗浄を術後に行い，再閉塞の有無を調べた。結果：12側（63％）が再閉塞していた。再閉塞がない7側中6側に，チューブを抜去したのち涙道を内視鏡で検索し，4側に狭窄があった。再閉塞した12側中6側に涙囊鼻腔吻合術を施行し，全例で良好な結果を得た。結論：鼻涙管完全閉塞のある症例では，チューブ挿入術の効果は限定的である可能性があり，涙囊鼻腔吻合術が将来必要になることがある。

Abstract.　Purpose：To report the outcome of silicone intubation, or therapeutic silicone tubing, for total nasolacrimal duct obstruction. Cases and Method：This retrospective study was made on 19 eyes of 17 patients who received silicone intubation for total nasolacrimal duct obstruction in the past 11 months. The therapeutic effect was checked by irrigation of lacrimal passage and by dacryoendoscopy. Result：Nasolacrimal duct obstruction recurred in 12 eyes（63％）. Dacryoendoscopy was performed in 6 out of 7 eyes that showed patent lacrimal passage after surgery. Stenosis of nasolacrimal duct was present in 4 of the 6 eyes. Out of 12 eyes with recurrence of nasolacrimal duct obstruction, dacryocystorhinostomy was performed in 6 eyes with favorable outcome. Conclusion：Silicone intubation is of limited value for total nasolacrimal duct obstruction. Unsuccessful cases may need additional dacryocystorhinostomy.