코경유 눈물주머니코안연결술의 학습곡선
Learning Curve for Endonasal Dacryocystorhinostomy
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목적: 1년간의 안성형전임의 과정을 마친 수술자가 처음 시행한 코경유 눈물주머니코안연결술의 수술 결과를 바탕으로 학습곡선을 알아보았다. 대상과 방법: 2006년 1월부터 2008년 1월까지 2년간 코경유 눈물주머니코안연결술을 시행 받은 환자 중 수술 후 6개월 이상 경과관찰 이 가능하였던 환자를 대상으로 의무기록을 후향적으로 분석하였다. 소아환자와 외상, 종양에 의한 코눈물관막힘 그리고 눈물소관폐 쇄는 대상에서 제외하였으며, 수술 후 눈물흘림증상의 유무, 주사기법을 이용한 눈물길관류검사로 성공여부를 판단하였다. 결과: 대상 환자는 총 161안이었으며, 평균경과관찰기간은 6.5개월이었다. 수술 후 전체성공률은 83.2% (134/161안)였다. 대상 환자를 8개월씩 시간순으로 1군(52안), 2군(53안), 3군(56안)으로 나누어 보았을 때 수술성공률은 1군이 71.2% (37/52안), 2군이 88.7% (47/53 안), 3군이 89.3% (50/56안)를 보여 수술성공률은 점차 의미 있게 증가함을 알 수 있었다(p=0.025, p=0.017). 결론: 코경유 눈물주머니코안연결술의 안정적인 술기를 위해서는 초심자에게 대략 50예 이상의 경험이 필요할 것으로 생각한다.
Abstract
Purpose: To determine the learning curve of dacryocystorhinostomy (DCR) performed by a single oculoplastic surgeon after one year of fellowship training. Methods: This retrospective review study comprised nasolacrimal duct obstruction patients that underwent endonasal DCR at our hospital between February 2006 and February 2008. The patients that completed at least six months of follow-up were included in the analysis. Exclusion criteria were patients less than 20 years of age and NLD obstructions due to malignancy or canalicular obstructions. Success was defined as duct patency on syringing at the final follow-up and no complaints of epiphora. Results: Out of 161 eyes, the overall surgical success rate was 83.2% (134/161 eyes) and the mean postoperative follow-up period was 6.5 months (6-18 months). Success rates gradually increased as follows: 71.2% (37/52 eyes) for the first group, 88.7% (47/53 eyes) for the second group, and 89.3% (50/56 eyes) for the third group (second and third group compared to first group, p = 0.025, p = 0.017, respectively). Conclusions: To ensure high DCR success rates, the novice surgeon should perform at least 50 surgeries.
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