눈물주머니 점막피판을 피브린접착제로 고정한 코경유눈물주머니코안연결술의 임상적 결과
Clinical Outcomes of Endonasal Dacryocystorhinostomy Using Fibrin Glue for Lacrimal Sac and Nasal Mucosal Flaps
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목적: 원발코눈물관막힘을 진단받고 코경유눈물주머니코안연결술을 받은 환자들에서 눈물주머니와 코점막의 피판을 만들지 않고 제거하는 수술 방법과 두 피판을 만들고 이를 피브린접착제로 부착한 방법을 시행하였을 때의 수술 후 골공 폐쇄 및 육아종 발생률에 있어 차이가 있는 지를 비교 및 평가하고자 한다. 대상과 방법: 총 45명 63안을 대상으로, 고식적인 방법으로 수술 시행한 대조군 25명 35안, 피브린접착제를 사용하여 피판으로 골공 부위를 덮어준 20명 28안에서 수술 후 1, 3, 6, 12개월 경과관찰 시 골공 부위의 육아종 형성률, 개통률 및 눈물흘림의 호전 여부에 대하여 비교해 보았다. 결과: 눈물주머니와 코 점막의 피판을 만들어 피브린접착제를 사용하여 골공 부위에 부착시킨 환자군에서 대조군에 비해 수술 후 3개월 경과관찰에서 환자들이 주관적으로 호소하는 눈물증상과 수술 후 6개월 째의 육아종 형성률이 유의미하게 낮게 관찰되었다(p<0.05). 결론: 피브린접착제를 사용하여 골공 부위 노출없이 점막피판을 사용하여 코경유눈물주머니코안연결술을 시행한 경우가 피판을 사용하지 않고 고식적인 방법으로 수술을 시행한 군에 비하여 3개월째 환자들의 눈물흘림 증상이 감소하였으며, 6개월째 육아종 형성률 및 개구부 폐쇄율 합병증이 적었다. 따라서 코경유눈물주머니코안연결술 시에 피브린접착제를 사용한 경우 추후 환자들의 눈물흘림 및 육아종 형성 면에 도움이 될 것으로 사료된다.
Abstract
Purpose: To assess the clinical outcomes of fibrin glue in endonasal dacryocystorhinostomy (DCR) for patients with primary nasolacrimal duct obstruction and to compare the surgical success rates between groups with the lacrimal sac flap using fibrin glue and without flap formation. Methods: In this prospective study, a total of 45 patients (63 eyes) underwent endonasal DCR. Fibrin glue was applied to the mucosal flap at the osteotomy site in the nasal cavity. The subjects were divided into two groups: group 1 (with lacrimal sac flap using fibrin glue), consisting of 20 patients (28 eyes), and group 2 (without flap), including 25 patients (35 eyes). To evaluate the two groups, subjective symptoms were asked to the patients, and endoscopic examinations were performed. Results: There were no statistically significant differences observed in terms of age, sex, timing of tube removal, or follow-up period between the groups. Group 1 showed significantly better results compared to the control group in terms of the degree of granuloma observed at 6 months postoperatively and the level of patient discomfort reported at 3 months postoperatively. Conclusions: Endonasal DCR with the lacrimal sac flap using fibrin glue achieves higher functional success, reduces patient discomfort at 3 months postoperatively, reduces granuloma formation at 6 months postoperatively, and improves membranous closure compared to flapless surgery
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