코 눈물관 폐쇄 환자에서의 Silastic Sheet를 이용한 눈물주머니 피판 코경유 눈물주머니코안연결술의 임상 결과
Results of Endonasal Dacryocystorhinostomy with Lacrimal Sac Flap and Silastic Sheet
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 코 눈물관 폐쇄 환자의 치료로서 silastic sheet를 이용한 눈물 주머니 피판 코경유 눈물주머니코안연결술의 임상 결과를 알아보고자 한다. 대상과 방법: 2009년 11월부터 2010년 12월까지 코 눈물관 폐쇄환자 54안 중 26안에 대해 silastic sheet를 이용한 눈물주머니 피판 코경유 눈물주머니코안연결술(1군)을 실시한 후 합병증, 수술 성공률에 대한 결과를 고식적 방법(2군)을 통해 수술한 28안과 비교 분석하였다. 결과: 1군의 해부학적인 성공률은 96.2%였으며 기능적 성공률은 100%였다. 통계학적으로 유의한 차이는 아니었으나 2군에서 각각 85.7%, 92.9%인 것에 비해 높게 나타났으며 육아종 형성은 피판을 이용한 군에서 15.4%로 고식적 방법 군의 32.1%보다 적었다. 결론: Silastic sheet를 이용한 눈물주머니 피판 코경유 눈물주머니코안연결술은 눈물주머니 피판을 이용하여 고식적 방법에서 문제점으로 작용했던 골부 노출에 의한 염증과 육아종 형성을 크게 줄이고 공통 눈물소관 주변 정상 구조를 최대한 유지해 합병증을 예방하고 성공률 또한 높일 수 있었다.
Abstract
Purpose: To investigate postoperative outcomes of endonasal dacryocystorhinostomy (DCR) using lacrimal sac flap and silastic sheet in patients with acquired nasolacrimal duct obstruction. Method: From November 2009 until December 2010, endonasal DCR with lacrimal sac flap was performed in 26 eyes (group 1) and conventional DCR without flap in 28 eyes (group 2). The anatomic and functional success rates and complications were analyzed and compared between the 2 groups. Results: The anatomical success rate was 96.2% in group 1 and 85.7% in group 2. The functional success rate was 100% in group 1 and 92.9% in group 2. The success rate was higher in group 1 than in group 2, although not being statistically significant. Granuloma was found in 15.4% of patients in group 1 and 32.1% of patients in group 2. Synechia or membranous obstruction was not found in group 1, whereas synechia developed in 14.3% of patients in group 2. Conclusions: Endonasal DCR with lacrimal sac flap showed a greater success rate and lower formation of granuloma than conventional endonasal DCR without flap because of reduced inflammation and granulation tissue formation around retained bony spicles.
참고문헌 (22)
- Caldwell GW, "Two new operations for obstruction of the nasal duct with preservation of the canaliculi and an incidental description of a new lachrymal probe", NY Med J, 57, pp.581~ (1983)
- McDonogh M, "Endoscopic transnasal dacryocystorhinostomy", J Laryngol Otol, 103, pp.585~587 (1989)
- Hong Ryul Jin, "Endoscopic Dacryocystorhinostomy: Creation of a Large Marsupialized Lacrimal Sac", Journal of Korean Medical Science, 21(4), pp.719~723 (2006), 대한의학회
- Rebeiz EE, "Endoscopic dacryocystorhinostomy", 7, pp.44~49 (1999)
- Onerci M, "Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy", Acta Otolaryngol, 120, pp.319~322 (2000)
- Durvasula VS, "Endoscopic dacrocystorhinostomy: lont-term results and evolution of surgical technique", J Laryngol Otol, 118, pp.628~632 (2004)
- Tsirbas A, "Endonasal dacryocystorhinostomy with mucosal flaps", Am J Ophthalmol, 135, pp.76~83 (2003)
- Munk PL, "Epiphora: treatment by means of dacryocystoplasty with balloon dilatation of the nasolacrimal drainage apparatus", wRadiology, 177, pp.687~690 (1990)
- Zílelíoğlu G, "Results of endoscopic endonasal non-laser dacryocystorhinostomy", Doc Ophthalmol, 105, pp.57~62 (2002)
- Mandeville JT, "Obstruction of the lacrimal drainage system", Curr Opin Ophthalmol, 13, pp.303~309 (2002)
- 이태수, "실패한 코경유눈물주머니코안연결술에서 교정수술의 결과", 대한안과학회지, 48(2), pp.186~192 (2007), 대한안과학회
- Sham CL, "Endoscopic terminal dacryocystorhinostomy", Laryngoscope, 110, pp.1045~1049 (2000)
- Wormald PJ, "Powered endoscopic dacryocystorhinostomy", Laryngoscope, 112, pp.69~72 (2002)
- Rhee KC, "The effect of mitomycin-C eyedrop on prevention of internal ostium obstruction after endonasal dacryocystorhinostomy", J Korean Ophthalmol Soc, 49, pp.2923~2927 (1998)
- Weidenbecher M, "Endoscopic endonasal dacryocystorhinostomy: Results in 56 patients", Ann Otol Rhinol Laryngol, 103, pp.363~367 (1994)
- Tsirbas A, "Mechamical endonasal dacryocystorhinostomy with mucosal flaps", Br J Ophthalmol, 87, pp.43~47 (2003)
- Massegur H, "Endoscopic dacryocystorhinostomy: Modified technique", Otolaryngol Head Neck Surg, 130, pp.39~46 (2004)
- Kansu L, "Comparison of surgical outcomes of endonasal dacryocystorhinostomy with or without mucosal flaps", Auris Nasus Larynx, 36, pp.555~559 (2009)
- Codère F, "Endonasal dacryocystorhinostomy: a modified technique with preservation of the nasal and lacrimal mucosa", Ophthal Plast Reconstr Surg, 26, pp.161~164 (2010)
- Yuen KS, "Modified endoscopic dacryocystorhinostomy with posterior lacrimal sac flap for nasolacrimal duct obstruction", Hong Kong Med J, 10, pp.394~400 (2004)
- Dhanasekar G, "Short-term results of endonasal dacryocystorhinostomy with a mucosal flap and a bone dissection technique", J Otolaryngol Head Neck Surg, 38, pp.390~394 (2009)
- Trimarchi M, "Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy", Eur Arch Otorhinolaryngol, 266, pp.1747~1752 (2009)