선천성 코눈물관 막힘 환자에서 내시경적 실리콘관 삽입술의 치료효과
The Clinical Outcome of Endoscopic Silicone Tube Intubation for Congenital Nasolacrimal Duct Obstruction
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목적: 선천성 코눈물관 막힘 환자에서 비내시경하에 해부학적 위치를 확인 후 실리콘관을 삽입하여 그 효과를 평가하였다. 대상과 방법: 선천 코눈물관 막힘으로 진단받은 환아 46명(58안)에서 비내시경하에서 하스너 밸브를 정확하게 확인하여 실리콘관을삽입하였고 적어도 12주간 관을 유지하였다. 결과: 대상안 중 수술 전 더듬자 시술에 실패한 기왕력이 있는 경우는 20안으로 평균 탐침 횟수는 1.7회이었다. 수술시 환아의 나이는최소 12개월 이상(평균 39.5개월)이었고, 실리콘 관의 유지기간은 평균 12.5주이었다. 평균 13.5개월의 경과관찰 기간 동안 58안 중1안을 제외한 57안에서 수술성공(98%)을 보였으며, 실패한 1안은 술 전 누소관 협착을 동반한 경우로, 술 후 실리콘관이 1주만에 조기이탈되어 증상 재발되었으며 4개월 후 재수술을 시행하여 호전되었다. 결론: 선천성 코눈물관 막힘 환자에서 실리콘관 삽입술 시행 시 비내시경하에 하스너 밸브를 확인하여 정확한 위치에 실리콘관 삽입이이루어진다면 환아의 연령, 술 전 치료 방법 등에 관계 없이 기능적으로 보다 높은 치료 성공률이 기대된다.
Abstract
Purpose: To evaluate the surgical results and clinical effectiveness of silicone tube intubation through Hasner’s valve under intranasal endoscopic guidance in children with congenital nasolacrimal duct obstruction (CNDO). Methods: The present study enrolled a total of 58 eyes of 46 children over 12 months of age diagnosed with CNDO in the Department of Ophthalmology, Inje University College of Medicine from 2003 to 2010. Patients who had previously undergone ineffective probing or had a combination of an anatomical abnormality such as secondary nasolacrimal duct obstruction were also included. The silicone tube was intubated through the Hasner’s valve and observed with intranasal endoscopy;tube retention time was planned for at least 12 weeks. Results: A total of 20 eyes were previously probed preoperatively (mean 1.7 times). After the average follow-up period of 13.5 months, the overall success of silicone intubation was 57 of 58 eyes (98%). In one failed eye, nasolacrimal obstruction was already combined preoperatively, and unintentional tube removal by the patient occurred within one week. Silicone tube reintubation was performed after four months, and CNDO symptoms improved. Conclusions: Intranasal endoscopic observation to ensure the passage of a silicone tube through Hasner’s valve decreases anatomical injury. When considering patient age and former treatment, silicone tube intubation with intranasal endoscopic observation could produce desirable results with a higher success rate.
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