항암화학요법과 방사성요오드치료 후 발생한 눈물길 폐쇄에서 눈물주머니코안연결술의 시행성적 비교
Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy
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목적: 항암화학요법 및 갑상선암에서 방사성요오드 치료 후 발생한 이차성 눈물길 폐쇄 환자에서 코경유눈물주머니코안연결술의 시행 성적을 비교하고자 하였다. 대상과 방법: 본원에서 항암화학요법을 시행하였거나 갑상선암에 대해 방사성요오드 치료를 시행 받은 후 눈물길 폐쇄를 진단 받고2009년 1월부터 2015년 1월까지 코경유눈물주머니코안연결술을 시행한 환자를 대상으로 하였고, 같은 기간 동안 일차성 눈물길 폐쇄로 코경유눈물주머니코안연결술을 시행한 환자를 무작위로 선정하여 대조군으로 설정하였다. 환자들의 수술 전후의 의무기록을 후향적으로 분석하였으며 수술 후 6개월까지 경과관찰 기간 동안 증상 및 눈물소관 관류검사를 토대로 수술의 성공률을 계산하였다. 결과: 항암화학요법군 9명 13안, 방사성요오드 치료군 32명 44안, 대조군 40명 50안을 비교하였으며 세 군 간의 나이, 성별 및 전체환자 중 양안 침범 환자의 비율은 통계적으로 유의한 차이가 없었다. 항암화학요법 혹은 방사성요오드 치료 후 눈물길 폐쇄의 증상발생까지 기간은 항암화학요법군에서 평균 4.2개월, 방사성요오드 치료군에서 평균 13.1개월로 항암화학요법군에서 통계적으로 유의하게 더 짧았다(p<0.001). 코경유눈물주머니코안연결술 시행 후 6개월 경과관찰 기간 동안 수술의 성공률 및 합병증 발생률은 세 군간에 유의한 차이가 없었다(p=0.542). 결론: 항암화학요법 혹은 방사성요오드 치료 후 발생한 이차성 눈물길 폐쇄 환자에서 코경유눈물주머니코안연결술은 대체적으로 성공적인 경과를 보였으며, 일차성 눈물길 폐쇄와 비교하였을 때 수술의 성공률에서 큰 차이가 없는 것으로 보인다.
Abstract
Purpose: To compare the outcomes of endonasal dacryocystorhinostomy in patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy. Methods: We retrospectively reviewed the clinical records of patients diagnosed with secondary lacrimal drainage obstruction after systemic chemotherapy or radioactive iodine therapy for thyroid disease and surgical treatment by endonasal dacryocystorhinostomy between January 2009 and January 2015. The control group included randomly selected patients who underwent endonasal dacryocystorhinostomy after diagnosis of primary lacrimal drainage obstruction. Results: Patients were separated into a chemotherapy group (13 eyes of 9 patients), a radioactive iodine therapy group (44 eyes of 32 patients), and a control group (50 eyes of 40 patients). Duration from the onset of systemic chemotherapy or radioactive iodine to the first epiphora symptom was shorter in the chemotherapy group than the radioactive iodine therapy group (p < 0.001). There was no significant difference between the three groups in success rate of endonasal dacryocystorhinostomy. Conclusions: Most patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy had successful outcome of endonasal dacryocystorhinostomy. The success rate of dacryocystorhinostomy was comparable to that in patients with primary lacrimal drainage obstruction.
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