코경유눈물주머니코안연결술 시 트리암시놀론을 적신 코충전물의 임상적 효과
The Clinical Effects of Triamcinolone-soaked Nasal Packing on Endonasal Dacryocystorhinostomy
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목적: 코경유눈물주머니코안연결술 중 트리암시놀론을 적신 코충전물을 사용하여 얻을 수 있는 임상적 효과를 알아보고자 하였다. 대상과 방법: 2015년 3월부터 2017년 2월까지 코눈물관막힘으로 코경유눈물주머니코안연결술을 시행받은 환자 91명, 156안을 코충전물로 트리암시놀론을 적신 NasoporeⓇ를 넣은 군(50안)과 트리암시놀론을 적시지 않은 NasoporeⓇ를 넣은 군(106안)으로 나누어 후향적 연구를 시행하였다. 수술 후 1주, 1, 2, 4개월에 눈물흘림 증상의 정도, 눈물소관 관류 검사, 비내시경 검사 결과를 평가하여 기능적 및 해부학적 수술 성공률, 재수술 여부, 합병증 발생 여부를 비교 분석하였다. 결과: 해부학적 수술 성공률은 수술 후 2개월에 트리암시놀론 사용군이 100%로 대조군 86.8%에 비해 통계학적으로 유의하게 높았으며(p=0.007), 술 후 4개월에는 유의한 차이를 보이지 않았다(p＞0.05). 기능적 수술 성공률은 수술 후 4개월에 트리암시놀론 사용군이 92.0%로 대조군 78.3%에 비해 통계학적으로 유의하게 높은 결과를 보였다(p=0.035). 수술 후 육아종은 트리암시놀론 사용군 2안(4.0%), 대조군 17안(16.0%)에서 발생하여 트리암시놀론 사용군에서 통계학적으로 유의하게 적었으며(p=0.032), 그 외 비강내 유착, 막 형성에서는 유의한 차이를 보이지 않았다(p＞0.05). 재수술이 필요한 경우는 트리암시놀론 사용군 2안(4.0%), 대조군 17안(16.0%)으로 트리암시놀론 사용군에서 통계학적으로 유의하게 더 적은 결과를 보였다(p=0.032). 결론: 코경유눈물주머니코안연결술 시 트리암시놀론을 적신 코충전물의 사용은 수술 성공률을 높이고 육아종 발생과 재수술률을 낮추는 데 효과적인 치료방법이 될 것으로 생각된다.
Abstract
Purpose: To evaluate the clinical effects of triamcinolone-soaked nasal packing on endonasal dacryocystorhinostomy (DCR). Methods: The study included 91 patients (156 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR from March 2015 to February 2017. A total of 50 eyes were packed with triamcinolone-soaked Nasopore® and 106 eyes were packed with Nasopore® without triamcinolone (control group). The anatomical and functional success percentage, revision percentage, and postoperative complications such as granulation, synechiae, and membrane formation were compared between the groups at 1 week, 1 month, 2 months, and 4 months postoperatively. Results: At postoperative 2 months, there was a statistically significant difference in the anatomical success percentage in the triamcinolone-soaked group (100%) compared to the control group (86.8%; p = 0.007). There were no statistically significant differences between the two groups in anatomical success percentage at postoperative 4 months (p > 0.05). However, there was a statistically significant difference in the functional success percentage in the triamcinolone-soaked group (92.0%) compared to the control group (78.3%; p = 0.035). When comparing postoperative complications, the triamcinolone-soaked group (4.0%) had a lower incidence of granulation than the control group (16.0%) (p = 0.032), but there were no differences in synechiae and membrane formation (p > 0.05). There was a statistically significant difference in the revision percentage in the triamcinolone-soaked group (4.0%) compared to the control group (16.0%) (p = 0.032). Conclusions: Triamcinolone-soaked nasal packing for endonasal DCR is an effective method for increasing the success percentage and lowering the incidence of granuloma and revision percentages.
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