코경유 눈물주머니코안연결술 전 통상적인 이비인후과 의뢰의 임상적 효용성
The Efficacy of Preoperative Routine Otorhinolaryngologic Referral Before Endonasal Dacryocystorhinostomy
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목적: EN-DCR (endonasal dacryocystorhinostomy) 환자의 통상적인 술 전 이비인후과 의뢰가 가지는 효용성에 대해 알아보았다. 대상과 방법: EN-DCR 환자 178명 237안을 대상으로 전향적 연구를 하였다. 안과의사가 코 내시경으로 코 안 이상유무를 먼저 확인하고심한 이상이 발견된 환자는 이비인후과에 의뢰하였다. 코 내시경 검사상 이상이 없는 환자를 A군, 코 안 이상으로 이비인후과 진료를보았으나 수술에 큰 문제가 없다고 판단되어 EN-DCR만 시행한 환자를 B군, 이비인후과 의뢰 후 EN-DCR과 함께 부가적인 이비인후과 치료를 시행한 환자를 C군으로 분류하여 각 군의 빈도 및 수술성공률을 분석하였다. 결과: 전체 178명의 환자 중 A군 156명, B군 12명, C군 10명이었고 심한 코 안의 이상으로 이비인후과 진료가 필요했던 환자는 총22명(12.3%)이었으며 군간 수술성공률은 통계적으로 차이가 없었다. 결론: EN-DCR 전 통상적인 이비인후과 의뢰의 필요성은 그리 크지 않을 것으로 생각하며 술 전 안과의사의 검사 후 필요한 환자의경우에만 이비인후과 진료를 의뢰한다면 환자의 시간적, 경제적 부담을 줄일 수 있을 것이다.
Abstract
Purpose: To determine if routine otorhinolaryngologic referral prior to endonasal dacryocystorhinostomy (EN-DCR) is necessary. Methods: Two hundred thirty-seven eyes of 178 patients who were supposed to undergo EN-DCR were prospectively analyzed. Nasal endoscopy was performed by an ophthalmologist and the patients who had severe abnormality were referred to an otorhinolaryngologist. The patients were classified into 3 groups after a preoperative examination by an ophthalmologist and an otorhinolaryngologist; the number and success rate of each group were then investigated. Group A consisted of patients who had no nasal cavity abnormality, Group B consisted of patients with a nasal cavity abnormality but who received no treatment, and Group C consisted of patients who had a nasal cavity abnormality and received otorhinolaryngologic treatment. Results: The number of subjects in each group was 156 in Group A (87.7%), 12 in Group B (6.7%), and 10 in Group C (5.6%). The number of patients who were referred to the otorhinolaryngologist was 22 (12.3%). There was no statistical significance of success rate between the groups. Conclusions: Routine nasal endoscopic examination should be performed by an ophthalmologist prior to EN-DCR. Only patients with severe abnormal findings should be referred to an otorhinolaryngologist as the results from the present study show the percentage of patients having significant nasal abnormalities was found to be low (12%) and the success rate of EN-DCR revealed no statistical significance between the groups. This could help patients by saving time and expense.
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