硬性内視鏡を用いた鼻涙管下部開口部観察時のポイント

Important points in examining the lower opening of nasolacrimal canal using hard type endoscope

　流涙症患者に対し鼻涙管チューブなどを挿入して，鼻涙管の鼻内開口部のチューブ先端を確認した。鼻内視鏡を用いて開口部を確認するためには，①上涙点から涙囊鼻側壁までの距離の平均値（14mm）を考慮した正確なプロービング，② 内視鏡検査前に血管収縮薬や希釈ボスミンを使用して確実に鼻粘膜の止血と収縮を行い，下鼻道の立体的な角度を把握すること，③ 外径2.7mmと4.0mmの内視鏡を用いて外鼻孔から鼻涙管開口部までの平均距離（27～43mm，平均34mm）を考慮して観察し，鼻内の全体像と涙道の3次元的な位置関係を把握することなどが重要と考えられた。

　To each of the patients with epiphora,nasolacrimal tube was inserted,and tip of the nasolacrimal tube at intranasal opening was confirmed. The results of our study suggest that special care must be taken on the following points for the purpose of confirming the opening by using intranasal endoscope：（1）Accurate probing must be carried out with special care and consideration on average value（14mm）of the distance from superior lacrimal puntum to nasal wall of lacrimal sac,（2）Hemostatic and contraction procedure for nasal mucasa should be performed by using vasoconstrictor or diluted Bosmin prior to the endoscopy,and 3-dimensional angle for inferior nasal meatus must be identified,（3）Using endoscope with inner diameter of 2.7mm and 4.0mm,average distance from nostril to the opening of nasolacrimal canal（27-43mm,average 34mm）should be determined,and the entire intranasal image and 3-dimensional positional relationship of lacrimal duct should be identified.