선천코눈물관막힘환자에서 코눈물관탐침술과 실리콘관삽입술의 임상 결과
Clinical Outcomes of Nasolacrimal Probing and Silicone Intubation in Patients with Congenital Nasolacrimal Duct Obstruction
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목적: 선천코눈물관막힘환자에서 코눈물관탐침술과 실리콘관삽입술의 효과와 수술 성공률에 영향을 주는 요인에 대해 알아보고자 한다. 대상과 방법: 탐침술을 받은 59명(69안)과 실리콘관삽입술을 받은 49명(61안)의 의무기록을 후향적으로 분석하였다. 탐침술을 받은 환아를 성공군과 실패군으로 나눠 연령, 성별, 보존적 치료 과거력 등을 조사하였고, 연령에 따라 1군(6개월 미만), 2군(6개월 이상12개월 미만), 3군(12개월 이상)으로 나눠 수술 성공률을 비교하였다. 실리콘관삽입술 환아는 성공군과 실패군으로 나눠 연령, 관 유지기간, 성별, 탐침술 및 보존적 치료 과거력 등을 조사하였다. 결과: 탐침술을 받은 환자에서 성공군에 비해 실패군에서 유의하게 평균 연령이 높았으며(p=0.005), 1군과 2군에 비해 3군에서 수술 성공률이 낮았다(p=0.005). 실리콘관삽입술 실패군에서 평균 연령은 유의하게 높았으나(p=0.015), 관 유지기간은 유의하게 짧았으며(p=0.006), 탐침술 과거력 또한 두 군 간에 유의한 차이를 보였다(p=0.009). 로지스틱 회귀분석에서는 연령 및 탐침술 과거력이 수술 성공률에 영향을 미치는 것으로 나타났으나(p=0.049, p=0.047), 관 유지기간은 유의한 차이를 보이지 않았다(p=0.411). 결론: 12개월 이상의 선천코눈물관막힘환자에서는 12개월 미만의 환자보다 탐침술의 수술 성공률이 낮고, 탐침술이 추후 실리콘관삽입술의 성공률에 영향을 미칠 가능성이 있다. 따라서 12개월 이상의 환자에서 탐침술보다 실리콘관삽입술을 우선적으로 고려할 수있다.
Abstract
Purpose: To investigate the efficacy and factors affecting the success rates of nasolacrimal probing and silicone intubation (SI) in patients with congenital nasolacrimal duct obstruction (CNLDO). Methods: We retrospectively reviewed the medical records of patients including 69 eyes of 59 patients who received probing and 61 eyes of 49 patients who received SI. In patients with probing, the age, sex, and history of conservative treatment were analyzed in the success and failure groups, and a success rate comparison was conducted by dividing these values into postnatal group 1 (< 6 months), group 2 (6-12 months), and group 3 (≥ 12 months) following their age. In patients with SI, the age, sex, retention period of the tube, and history of probing and conservative treatment were analyzed in the success and failure groups. Results: In the failure group involving probing, the average age was significantly higher compared with the success group (p = 0.005), and the success rate of group 3 was significantly lower compared with group 2 (p = 0.005). In the failure group involving SI, the age was significantly higher (p = 0.015); however, the retention period was shorter (p = 0.006), and the history of probing also showed a statistically significant difference between the two groups (p = 0.009). Logistic regression analysis showed that the age and history of probing had an effect on the success rate (p = 0.049 and p = 0.047, respectively); however, the retention period was not statistically significant (p = 0.411). Conclusions: In patients with CNLDO > 12 months, the success rate of probing was lower than in patients < 12 months, and probing might have an effect on the success rate of future SIs. It is therefore recommended that SI be preferentially performed on patients > 12 months.
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