코경유눈물주머니코안연결술 시 calcium alginate와 polyurethane foam의 효과 비교
Comparison of Calcium Alginate and Polyurethane Foam Used as Nasal Packings after Endonasal Dacryocystorhinostomy
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목적: 코경유눈물주머니코안연결술 시 비강 내에 삽입하는 흡수성 충전 물질인 calcium alginate (Algi-packⓇ)와 polyurethane foam (NasoporeⓇ)의 수술 후 결과에 미치는 영향을 비교하고자 하였다. 대상과 방법: 2008년 1월부터 2016년 7월까지 본원에서 원발코눈물관막힘으로 한 명의 집도의에 의해 코경유눈물주머니코안연결술을 받은 환자 중 조건에 부합하는 총 128안을 후향적으로 조사하였다. Algi-packⓇ 사용군에는 42안이 포함되었고, NasoporeⓇ 사용군에는 86안이 포함되었다. 술 후 2일째 통증의 정도, 1주일 내 재출혈 여부, 3개월 후 해부학적 및 기능적 성공률, 3개월 후 비강 내 유착, 수술 부위 육아종, 막형성 등을 평가하여 Algi-packⓇ 사용군과 NasoporeⓇ 사용군을 비교하였다. 결과: 술 후 통증의 정도 및 재출혈 빈도는 두 군 간에 유의한 차이가 없었으며(통증: 73.8% vs. 83.7%, p=0.38; 재출혈: 4.8% vs. 5.8%, p=0.058). 3개월 후 수술 부위 육아종, 비강 내 유착 및 막형성 빈도에는 유의한 차이가 없었다(육아종: 33.3% vs. 29.1%, p=0.62; 비강 내 유착: 1.2% vs. 4.8%, p=0.21; 막형성: 19.0% vs. 12.8%, p=0.35). 3개월째 해부학적 및 기능적 성공률 또한 두 군 간의 유의한 차이를 보이지 않았다(해부학적: 100% vs. 97.7%, p=0.32; 기능적: 100% vs. 95.3%, p=0.16). 결론: 코경유눈물주머니코안연결술 후 충전 물질로 사용하는 Algi-packⓇ과 NasoporeⓇ는 수술 부위 지혈 효과에 있어서 동등한 효과를 보이며 수술 결과에 있어서도 유의한 차이를 보이지 않는다.
Abstract
Purpose: To compare the effectiveness of calcium alginate (Algi-packⓇ)and polyurethane foam (NasoporeⓇ), two types of absorbable packing used for nasal packing after endonasal dacryocystorhinostomy. Methods: We performed a retrospective chart review of 128 eyes of patients who underwent endonasal dacryocystorhinostomy from January 2008 to July 2016. Algi-packⓇ was used to pack 42 eyes and NasoporeⓇ in 86 eyes. We compared the two groups in terms of pain on postoperative day 2; the re-bleeding frequency within 1 week; anatomical and functional success rates 3 months after surgery; and the frequencies of postoperative complications including synechiae, granulomas, and membrane formation at 3 months postoperatively. Results: There was no significant difference between the Algi-packⓇ and NasoporeⓇ groups in terms of postoperative pain or re-bleeding rate (pain: 73.8% vs. 83.7%, p = 0.38; re-bleeding: 4.8% vs. 5.8%, p = 0.058). There was no significant between- group difference in terms of the formation of synechiae, granulomas, or membranes to 3 months postoperatively (granulomas: 33.3% vs. 29.1%, p = 0.62; synechiae: 1.2% vs. 4.8%, p = 0.21; membranes: 19.0% vs. 12.8%, p = 0.35). The functional and anatomical success rates evaluated 3 months after surgery also did not differ significantly between the two groups (anatomical success: 100% vs. 97.7%, p = 0.32; functional success: 100% vs. 95.3%, p = 0.16). Conclusions: Algi-packⓇ and NasoporeⓇ equivalently suppressed bleeding after endonasal dacryocystorhinostomy and did not differentially affect the surgical success rate or the frequency of postoperative complications.
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