성인 코눈물관막힘에서의 눈물길미세내시경 실리콘관삽입술과 코경유눈물주머니코안연결술
Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction
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목적: 눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자에서 눈물길미세내시경 실리콘관삽입술을 시행한 경우와 코경유눈물주머니코안연결술을 시행한 경우 간의 치료 효과를 비교하고자 하였다. 대상과 방법: 눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자로 전체 50명(68안) 중 눈물길미세내시경 실리콘관삽입술을 받은 경우(21명, 31안)와 코경유눈물주머니코안연결술을 받은 경우(29명, 37안)를 후향적으로 비교하였다. 결과: 눈물길미세내시경 실리콘관삽입술을 시행한 경우 술 후 3개월 및 6개월의 성공률은 전체 31안 중 27안(87.1%), 22안(71.0%)을 보였다. 코경유눈물주머니코안연결술 환자군에서는 술 후 3개월 및 6개월의 성공률은 전체 37안 중 34안(91.9%), 30안(81.1%)을 보였다. 술 후 3개월 및 6개월의 성공률 모두 유의한 차이가 없었으나(p=0.517, p=0.327), 술 전 눈물소관관류검사에서 완전폐쇄를 보이는 경우 술 후 6개월 코경유눈물주머니코안연결술(81.8%)이 눈물길미세내시경 실리콘관삽입술(33.3%)보다 유의하게 높은 성공률을 보였다(p=0.028). 결론: 눈물소관막힘이 없는 후천코눈물관막힘 환자에서 눈물길미세내시경을 이용한 실리콘관삽입술은 환자에서 코경유눈물주머니코안연결술과 동등한 성공률을 보였으나, 코눈물관의 완전폐쇄가 있는 환자의 경우에는 낮은 성공률을 보였다. 눈물길미세내시경 실리콘관삽입술을 이용하여 불필요한 침습적 수술과 전신마취 및 합병증을 줄일 수 있을 것으로 보인다.
Abstract
Purpose: To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. Methods: Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. Results: For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). Conclusions: There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.
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