涙嚢鼻腔吻合、涙嚢鼻腔吻合術

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/08 12:27:23」(JST)

wiki en

Dacryocystorhinostomy (DCR) is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.

Process

Traditional

A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. Drains are left behind to prevent the gap from becoming closed and are removed after a few months. A Jones or Crawford Tube is placed to facilitate the flow of tears from the eye to the nose. The Lacrimal Sacs must be avoided during this surgical procedure.

Endoscopic

The operation can also be performed endoscopically through the nose where an opening is fashioned in the lacrimal sac from within the nose. The advantages include lesser peri-operative morbidity, and no scar. Data suggests a slightly lower success rate than the "traditional" technique.

With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. The bone covering the lacrimal sac is nibbled out. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. This procedure avoids scarring.

Contraindications

Atrophic rhinitis is an absolute contraindication. In case of acute dacryocystitis, this operation can not be done immediately, rather it is done after a period of time. In case of elderly patients (above 70 years of age), dacryocystectomy is preferred to dacryocystorhinostomy as old age naturally causes atrophy in nasal mucosa.

External links

eMedicine: Dacryocystorhinostomy
drtbalu surgical videos

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児における先天性鼻涙管閉塞（涙管閉鎖症）および涙嚢ヘルニア congenital nasolacrimal duct obstruction dacryostenosis and dacryocystocele
2. 慢性腎疾患関連眼疾患 eye disorders associated with chronic kidney disease

English Journal

Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications.

Marcet MM1, Kuk AK, Phelps PO.
Current opinion in ophthalmology.Curr Opin Ophthalmol.2014 Sep;25(5):443-8. doi: 10.1097/ICU.0000000000000084.
PURPOSE OF REVIEW: To review the current surgical practices in endoscopic endonasal dacryocystorhinostomy (EN-DCR) from the studies of last 12 months.RECENT FINDINGS: Success rates in EN-DCR now rival those of the conventional external approach. Indications are expanding beyond primary acquired naso
PMID 24979582

Proteus mirabilis and Its Role in Dacryocystitis.

Borgman CJ.
Optometry and vision science : official publication of the American Academy of Optometry.Optom Vis Sci.2014 Sep;91(9):e230-5. doi: 10.1097/OPX.0000000000000347.
PURPOSE: Dacryocystitis is a common inflammation of the lacrimal sac, usually from an underlying bacterial infection. Most cases can be attributed to common ocular flora such as Staphylococcus aureus or Streptococcus pneumoniae; however, uncommon bacterial causes such as Proteus mirabilis can still
PMID 25036545

Long-term outcomes in revision powered endoscopic dacryocystorhinostomy.

Ali MJ1, Psaltis AJ, Wormald PJ.
International forum of allergy & rhinology.Int Forum Allergy Rhinol.2014 Aug 31. doi: 10.1002/alr.21398. [Epub ahead of print]
BACKGROUND: Long-term outcomes of revision dacryocystorhinostomy are less known. The aim of this study was to assess the long-term outcomes of revision powered endoscopic dacryocystorhinostomy (DCR).METHODS: Retrospective review of all consecutive revision powered endoscopic DCRs performed over a pe
PMID 25175719