鼻涙管閉塞に対する涙道内視鏡下涙管チューブ挿入術の治療成績と術前培養菌種の検討

Outcome of endoscopic nasolacrimal duct intubation and findings by culture of microorganisms before surgery

要約　目的：鼻涙管閉塞に対する涙道内視鏡下涙管チューブ挿入術の治療成績に対する術前分離菌の関与の検討。

対象と方法：2010年11月〜2014年9月に涙道内視鏡下涙管チューブ挿入術を施行し，術前涙囊分泌物を培養し，かつ涙管チューブ抜去後6か月以上経過観察できた64例74側を対象とし，菌種ごとの再発率を分離の有無で比較検討した。

結果：術後経過観察期間は10.8±9.3か月，術後再発は16側（21.6％），菌分離は58側（78.4％）に認めた。分離菌種数における再発率は，菌分離なし群12.5％，1種分離群7.7％，2種以上分離群37.5％と3群間で有意差を認めた（p＝0.0141）。各菌種の分離群と非分離群で再発率を検討すると，Streptococcus anginosus groupにおいて分離群が非分離群より有意に再発率が高かった（p＝0.0192）。

結論：涙囊炎起因菌種と分離菌種数により，涙管チューブ挿入術後成績が異なる可能性がある。

Abstract　Purpose: To report the outcome of endoscopic nasolacrimal duct intubation as related to cultured microorganisms in nasolacrimal duct obstruction.

Case and Method: This study was made on 74 sides of 64 patients who received endoscopic nasolacrimal duct intubation during 45 months through September 2014. The age ranged from 39 to 90 years, average 72 years. Discharge from lacrimal ducts was cultured before surgery. Patients were followed up for 6 months or longer after removal of lacrimal tube.

Results: During the follow-up for an average of 10.8 months, nasolacrimal duct obstruction recurred in 16 out of 74 sides（21.6％）. Overall rate of positive microbial growth was 58 out of 74 specimens（78.4％）. Rate of recurrence was higher when two or more species were involved（37.5％）than when one or no species was involved（7.7％ and 12.5％ respectively）. The difference was significant（p＝0.0141）. Rate of recurrence was significantly higher when culture for Streptocococcus angiosus group was positive than in culture-negative cases（p＝0.0192）.

Conclusion: Outcome of endoscopic nasolacrimal duct intubation differed dependent on the species and number of causative microorganisms.