내시경 결막누낭비강연결술 재수술 사례의 후향적 분석
A Retrospective Review of Endoscopic Conjunctivodacryocystorhinostomy Reoperation Cases
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목적: 비강을 통한 내시경 결막누낭비강연결술 재수술의 후향적 분석을 통하여 재수술의 성공률과 원인 등을 알아보고자 하였다. 대상과 방법: 2013년 1월부터 2018년 12월 사이 비강을 통한 내시경 결막누낭비강연결술의 재수술을 시행 받은 환자 40명(41안, 52예)을 대상으로 후향적 연구를 통해 재수술의 성공률과 원인, 삽입된 존스관의 길이 변화, 최초 수술로부터 첫 번째 재수술까지의 간격, 2회 이상의 재수술 시 해당 수술 사이의 간격을 분석하였다. 결과: 재수술을 받게 된 원인은 존스관의 내측 이동(53.8%)이 가장 많았으며, 관의 유실(17.3%), 관의 폐쇄(13.46%), 관의 외측 이동(11.53%), 의료진에 의한 관의 제거(1.92%), 급성누낭염(1.92%) 순이었다. 존스관의 길이는 관의 내측 이동이 원인일 경우 1.11 mm 감소하였고, 외측 이동이 원인일 경우 1.00 mm 증가하였다. 재수술 성공률은 78.04%였다. 관찰기간 내 재수술이 첫 재수술이었던 27안에서는 재수술까지의 평균 기간이 52개월이었다. 2번 이상의 재수술을 시행한 경우, 재수술 간 평균 기간은 24개월, 14개월로 재수술횟수가 늘수록 간격은 점차 짧아졌다. 결론: 존스관의 내측 이동은 재수술의 가장 흔한 원인이다. 재수술 시 삽입된 존스관의 길이 변화는 관의 이동 방향과 연관성이 있었으며, 이는 예후 예측에 고려해야 할 부분이다. 비강을 통한 내시경 결막누낭비강연결술의 재수술 성공률은 좋은 편이었다. 반복되는 재수술 시 그 원인에는 경향성이 없었으나 수술 간격은 점차 짧아지는 양상을 보였다.
Abstract
Purpose: To analyze the causes, success rate, and the changes of Jones tube length in endoscopic conjunctivodacryocystorhinostomy (CDCR) reoperation cases. Methods: The medical records of 40 patients (41 eyes, a total of 52 cases) who underwent reoperation of CDCR with Jones tube reinsertion using an endoscope from January 2013 to December 2018 were retrospectively reviewed. We analyzed the success rate, causes of reoperation, changes in lengths of used tubes, and the average interval times between operations. Results: The most common cause of reoperation was medial tube migration (53.8%). As in other causes, tube loss (17.3%), obstructions related with conjunctival overgrowth or granulation (13.46%), lateral tube migration (11.53%), iatrogenic removal (1.92%), and acute dacryocystitis (1.92%) followed. In patients with medial tube migration, the average tube length used in reoperations decreased by approximately 1.11 mm compared to prior operations. In cases of lateral tube migration, the average tube length increased approximately 1.00 mm after the reoperation. The success rate of reoperations was 78.04%. The average interval time between the initial operation and the first reoperation was 52 months. In cases with several reoperations, the interval time decreased as the number of reoperations increased. Conclusions: Because medial tube migration was found to be the most common cause of reoperations, it should be considered as a potential problem when performing surgery. The changes in the lengths of inserted Jones tubes were related to certain types of complication, which affected the prognoses. In endoscopic CDCR reoperations, the success rate was favorable. In recurrent cases, the average interval time between reoperations decreased as the number of operations increased.
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