涙嚢鼻腔吻合術において再評価されるべき端一側吻合法について

Reappraisal of dacryocystorhinostomy by end-to-side anastomosis

　涙嚢鼻腔吻合術での端一側吻合は合理的な術式であるが，第一選択としては評価されていない。筆者らは涙嚢粘膜と鼻粘膜との吻合法を改良した。互いの粘膜を直接には縫合せず，骨窓の辺縁に作成した4個の小孔を介して，鼻涙管の断端にかけた縫合糸を牽引し，断端を密着させるようにした。縫合糸は眼窩側で結紮し，鼻涙管断端をラッパ状に開いた形で固定し，さらに涙嚢の眼球側の壁を剥離して吻合部の緊張を減少させた。再手術を含めた81眼での手術成績は，治癒が73眼（90％），有効が6眼（7％），無効が2眼（3％）であった。

Dacryocystorhinostomy by end-to-side anastomosis is a logically reasonable method but has not been accepted as the first choice. We modified the surgical procedure to anastomose the mucous membranes between the lacrimal sac and the nasal cavity. Instead of direct suture, the cut end of the lacrimal sac is sutured through four small openings along the margin of the bony window to induce firm adherence to the nasal mucosa. The lateral wall of the lacrimal sac is gently severed from the surrounding tissue to induce relaxation of the anastomosed site. We treated 81 eyes with this procedure. The outcome was judged as cure in 73 eyes (90%) , effective in 6 (7%) and failure in 2 (3%).