코경유 눈물주머니코안연결술시 동시에 시행한 비강내 시술
Intranasal Procedures for Endonasal Dacryocystorhinostomy
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목적: 코경유 눈물주머니코안연결술시 골공을 적절히 노출시키기 위해 필요했던 코안 구조물의 시술에 대해 알아보고자 한다. 대상과 방법: 2010년 1월부터 12월까지 코경유 눈물주머니코안연결술을 받았던 52명, 66안의 의무기록과 수술비디오를 분석하였다. 굴곡광원을 사용하여 내누점 위치를 중간코선반덮개를 기준으로 4군으로 나누고 골공을 노출시키기 위해 시행한 비강내 구조물에 대한수술에 대해 분석하였다. 결과: 굴곡광원으로 관찰되는 내누점 위치는 중간코선반덮개를 기준으로 후상방 37예(56%), 전상방 16예(24%), 후하방 11예(17%), 전하방 2예(3%)였다. 중간코선반덮개는 63예(95%)에서 기시부의 부분적 제거가 필요하였고 중간코선반은 43예(65%)에서 앞부분을 부분절제하였다. 구상돌기는 62예(94%), 벌집뼈 공기세포는 45예(68%)에서 부분적 절제가 필요하였다. 결론: 한국인에서 코경유 눈물주머니코안연결술시 적절한 크기의 골공을 만들기 위해 다수에서 코안 구조물의 부분적 제거가 필요하였다. 술 중 굴곡광원의 사용은 내누점의 위치를 확인하여 눈물주머니의 위치를 찾고 골공 형성을 위해 제거가 필요한 구조물을 확인하는데 도움이 된다.
Abstract
Purpose: To describe the rate of surgical intervention to the intranasal structures for making a sufficient bony ostium in endonasal dacryocystorhinostomy. Methods: Video records of 52 Korean patients (66 eyes) who underwent endonasal dacryocystorhinostomy between January 2010 and December 2010 for primary nasolacrimal duct obstruction were reviewed. To locate the internal common punctum in the lateral nasal wall, a transcanalicular illumination device consisting of disposable vitrectomy light pipe was introduced horizontally through the canaliculus. The relative position of the internal common punctum to the operculum of the middle turbinate was divided into 4 types and analyzed according to the intranasal surgical procedures necessary. Results: Internal common punctum was located posterior-superior to the operculum of the middle turbinate in 37 cases (56%), anterior-superior in 16 cases (24%), posterior-inferior in 11 cases (17%) and anterior-inferior in 2 cases (3%). To expose the bony ostium, partial removal of the operculum of the middle turbinate was required in 63 cases (95%), anterior middle turbinectomy in 43 cases (65%), uncinectomy in 62 cases (94%) and opening of the agger nasi cell in 45 cases (68%). Conclusions: In a majority of patients, partial removal of the middle turbinate, uncinate process and agger nasi cell were necessary to create a sufficient bony ostium. The transcanalicular illumination device is useful to locate the lacrimal sac and can be helpful in understanding the intranasal structures which need to be removed during surgery.
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