局所麻酔下において鼻内視鏡下で先天涙囊瘤を治癒できた症例

Cases of congenital dacryocystocele treated using nasal endoscopy under local anesthesia

要約　目的：先天涙囊瘤を受診当日に局所麻酔下で診断と治療を行った症例を経験したので報告する。

症例：内眼角部に暗青色の腫瘤を認め，先天涙囊瘤を疑った生後2日〜2か月の女児4症例。鼻内視鏡観察下で，下鼻道に脱出する瘤を認めたため先天涙囊瘤と診断した。0.1％エピネフリン，2％キシロカインを用いて，鼻粘膜の麻酔・収縮を行った。麦粒鉗子を用いて，鼻内視鏡観察下で経鼻的造瘻術を施行した。瘤内から粘液性の液体の排出を認め，速やかに内眼角部の腫瘤は改善した。周術期に患児の異常を認めなかった。

結果：先天涙囊瘤に対し，局所麻酔下で鼻内視鏡を用いて確定診断および手術が行えた。

結論：先天涙囊瘤は，鼻内視鏡で下鼻道にある瘤を認めることが可能であれば局所麻酔下で治療可能な疾患である。

Abstract　Objective：To report cases of congenital dacryocystocele as that diagnosed and treated under local anesthesia on the same day of the consultation.

Cases Description：Four girls aged 0 to 2 months, suspected to have congenital dacryocystcele due to a dark blue mass in the inner eye angle, presented to us. At the time of initial examination, nasal anesthesia with 0.1％ epinephrine＋2％ xylocaine was administered to all four patients and nasal endoscopy was performed. The mass was incised with a grain forceps under nasal endoscopy, and mucous discharge was observed within the mass. Immediately postoperatively, improvement of the bulge in the internal eye angle was observed. There were no abnormalities in the general condition of the patients postoperatively. Nasal endoscopy was performed under local anesthesia to establish a definitive diagnosis and perform surgically manage a congenital dacryocystocele.

Conclusion：Congenital dacryocystocele detected as a mass in the inferior nasal canal through nasal endoscopy can be treated under local anesthesia.