성공적인 코경유 눈물주머니코안연결술의 예측인자
Prognostic Factors for Successful Endonasal Dacryocystorhinostomy
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목적: 코경유 눈물주머니코안연결술의 수술 결과를 예측할 수 있는 인자를 찾아보고자 하였다. 대상과 방법: 코눈물관막힘 진단하에 코경유 눈물주머니코안연결술을 시행하고 6개월 이상 경과를 관찰한 94명 117안을 대상으로 후향적 분석을 시행하였다. 수술 성공과 연관이 있는 요인을 술 전 요인, 술 중 요인, 술 후 임상 소견으로 분석하였다. 술 전 요인으로나이, 성별, 좌우안, 고혈압과 당뇨 유무를 분석하였고, 술 중 요인으로 트리암시놀론 사용 여부, 술 중 구상돌기나 중간코선반 제거여부, 눈물주머니의 위치를 분석하였다. 술 후 임상 소견으로 눈물띠가 높은 경우, 코안 실리콘관 움직임이 없는 경우, 공기역류를느끼지 못하는 경우를 각각 1점으로 하여, 합산 점수가 낮은 군과 높은 군으로 나누어 분석하였다. 결과: 수술 성공률은 91.5%였다. 당뇨가 있는 경우 수술 성공률이 73.3%로 유의하게 낮았다(p=0.007). 술 후 3, 6, 9주째에 높은 눈물띠를 보인 경우 수술 성공률이 76.9%, 81.8%, 75.0%로 유의하게 낮았다(p=0.003, p=0.029, p=0.002). 술 후 3, 6주째에 낮은 점수군은 수술 성공률이 100%, 95.9%로 유의하게 높았다(p＜0.001, p=0.023). 결론: 수술 성공을 예측하기 위하여 술 전, 술 중 요인에 대한 평가뿐만 아니라, 술 후 임상소견에 대한 평가도 유용하게 사용될 수있을 것으로 생각된다. 수술 후 초기에 눈물띠가 높고, 코안 실리콘관의 움직임, 공기역류가 관찰되지 않는다면 더 적극적인 관리가필요할 것으로 생각된다.
Abstract
Purpose: To evaluate the factors useful for predicting the surgical outcome of endonasal dacryocystorhinostomy. Methods: This retrospective observational study included 117 eyes of 94 patients with nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy and were followed up for more than 6 months. Factors associated with successful surgery were analyzed based on the preoperative and intraoperative factors and postoperative clinical features. Preoperative factors such as age, gender, laterality, presence or absence of hypertension, and diabetes were analyzed. Intraoperative factors such as use of triamcinolone, removal of uncinate process or middle turbinate during surgery, and location of the sac were analyzed. The postoperative clinical features including high tear meniscus, no intranasal silicone tube movement, and no air reflux feeling were each given a score of 1. Based on aggregate score, the patients were divided into 2 groups, the high score and low score groups and analyzed accordingly. Results: The success rate was 91.5%. Patients with diabetes showed a significantly low success rate (73.3%, p = 0.007). In patients with high tear meniscus at 3, 6, and 9 weeks after surgery, the success rate was significantly low (76.9%, 81.8% and 75.0%; p = 0.003, p = 0.029 and p = 0.002, respectively). The low score group at 3 and 6 weeks after surgery showed a significantly high success rate (100% and 95.9%; p < 0.001 and p = 0.023, respectively). Conclusions: Besides preoperative and intraoperative factors, the early postoperative clinical features are important for predicting the success of the surgery. If tear meniscus is high and there is no intranasal silicone tube movement and air reflux from the punctum in the early stages after surgery, more active management from the initial treatment is needed.
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