涙囊鼻腔吻合術鼻内法を施行した急性涙囊炎の2例

Two cases of acute dacryocystitis treated by endonasal dacryocystorhinostomy

要約　目的：急性涙囊炎の発症早期に涙囊鼻腔吻合術鼻内法を施行した2例の報告。症例：59歳と78歳の両症例とも急性涙囊炎を鎮静化させた後に手術を計画した。しかし，術直前に再発し抗菌薬の全身投与を行いつつ，予定通り鼻内から手術を施行した。症例1は術後に37.7℃まで発熱したが，2例とも術後は速やかに消炎され経過は良好であった。チューブ抜去後6か月目，開窓部はともに良好で開大していた。所見：症例1は，術前から発熱を呈し内眼角の発赤や疼痛が強かった。症例2は，複数回の涙囊穿刺を施行しており，術中操作が複雑となりやや出血が多かった。結論：急性早期の手術でも重篤な合併症はなく，鼻内法の選択が有用であった。

Abstract.　Purpose：To report two cases who received endonasal dacryocystorhinostomy for acute dacryocystitis in its early stage. Cases：Both were females aged 59 and 78 years respectively. One case had fever when first seen and showed hyperemia and pain in the medial canthus. The other case had multiple punctuations of the lacrimal sac. Surgery was initially planned after improvement of acute lesion. Surgery by endonasal approach had to be performed according to schedule as dacryocystitis recurred just before surgery in spite of antibiotics. While one case developed fever after surgery,both cases promptly showed reduced inflammation with good final outcome. The lacrimal tract remained open in both cases after removal of tubing 6 months later. Conclusion：Dacryocystorhinostomy by endonasal approach was safe and effective in two cases of acute dacryocystitis in its early stage.