和歌山医大での内視鏡下涙管チューブ挿入術の手術成績の検討

Outcome of lacrimal intubation under endoscopic observation at Wakayama Medical University

要約　目的：和歌山医大で開始第1症例から約2年の内視鏡下涙管チューブ挿入術全症例について検討を行った。

対象と方法：当院で施行した57例68側について検討した。全症例を1名の術者が執刀した。

結果：全症例でのチューブ挿入完了率は79.4％であった。涙小管閉塞症例の完了率は0％，涙点閉鎖では50.0％であった。背景因子との関係では，抗癌剤内服既往は50.0％，外傷後長期経過は0％，急性涙囊炎後で75.0％であった。

結論：涙小管閉塞，外傷後長期経過，急性涙囊炎後で自壊創ありを内視鏡下涙管チューブ挿入術で治療困難と考えた。これらの因子がない場合，初心者では開始半年後以降は92.5％で挿入完了が可能であった。

Abstract　Purpose: To report the 2-year outcome of intubation for lacrimal duct obstruction under endoscopic observation at Wakayama Medical University Hospital.

Cases and Method: This retrospective study was made on 68 sides of 57 cases who received insertion of lacrimal tube under endoscopic observation during the past 2 years. The series comprised 25 male and 43 female sides. The age ranged from 48 to 92 years, average 71 years. Surgery was performed by one surgeon throughout.

Results: The lacrimal tube could be inserted in 79.4％ of eyes. It was inserted in 50.0％ of cases with obstruction of lacrimal puncta and in 0％ of eyes with obstructed canaliculus. It could be inserted in 75.0％ of cases following acute dacryocystitis, in 50.0％ of cases with previous treatment with systemic anticancer drugs, and in 0％ cases after longstanding traumatic obstruction.

Conclusion: Insertion of lacrimal tube was difficult in cases with obstructed canaliculis, and cases with past history of trauma or dacryocystitis. Otherwise, surgery could be performed in about 92.5％ of cases.