눈꺼풀 악성종양 수술에서 눈꺼풀 전층절제 후 시행한 직접봉합법의 미용적 효과
The Cosmetic Effects of Full Thickness Eyelid Resection and Direct Closure for Eyelid Malignant Tumors
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목적: 눈꺼풀 악성종양의 절제 후 발생한 40-70%의 눈꺼풀 결손을 직접봉합법 혹은 직접봉합법과 가쪽눈구석절개술 및 가쪽눈구석인대절단술로 재건하여 수술 전후 눈꺼풀의 변형 여부와 만족도를 조사하였다. 대상과 방법: 2009년 1월부터 2016년 6월까지 눈꺼풀 악성종양으로 진단되어 수술 후 40-70%의 눈꺼풀 결손이 동반된 환자 중, 직접봉합법 혹은 직접봉합법과 가쪽눈구석절개술 및 가쪽눈구석인대절단술을 시행하여 눈꺼풀 결손을 재건한 환자의 의무기록을 후향적으로 분석하였다. 나이, 성별, 진단명, 종양의 위치, 만족도, 합병증 여부를 조사하였고 정상안과 비교한 눈꺼풀틈새 수평길이와 높이의 비율을 수술 전후로 비교하여 눈꺼풀의 변형 여부를 확인하였다. 결과: 20명의 환자에서 수술 3개월째 만족도는 매우 만족 12명(60%), 만족 5명(25%), 보통 3명(15%)이었다. 수술 전 정상안과 비교한 눈꺼풀틈새 수평길이의 비율은 평균 1.03 ± 0.01, 높이의 비율은 평균 1.08 ± 0.30이었고, 수술 후 정상안과 비교한 눈꺼풀틈새 수평길이의 비율은 평균 1.04 ± 0.08, 높이의 비율은 평균 1.01 ± 0.17이었다. 눈꺼풀틈새 수평길이와 높이 모두에서 수술 전후 유의한 차이는 없었다(p=0.314, 0.087). 결론: 눈꺼풀 악성종양의 절제로 40-70%의 큰 범위의 눈꺼풀 결손이 동반된 경우에 피판법, 이식법 등을 시행하지 않고, 직접봉합법 또는 직접봉합법과 가쪽눈구석절개술 및 가쪽눈구석인대절단술을 시행한 것만으로도 눈꺼풀의 변형 없이 만족스러운 결과를 얻을 수 있다.
Abstract
Purpose: To evaluate the degree of eyelid deformation and satisfaction after direct closure in patients with 40-70% eyelid defects after resection of an eyelid malignant tumor. Methods: We retrospectively reviewed the clinical records of patients diagnosed with eyelid malignant tumors between January 2009 and June 2016, who were treated with resection of 40-70% of the eyelid, followed by reconstructed direct closure only or by direct closure with lateral canthotomy and cantholysis. Age, sex, diagnosis, tumor location, satisfaction, and complications were analyzed, and the ratio of horizontal width ratio and vertical height ratio were compared before and after surgery. Results: The results of satisfaction were: 12 patients (60%), very good; five patients (25%), good; and three patients (15%), fair. The average preoperative horizontal width ratio and vertical height ratio were 1.03 ± 0.01 and 1.08 ± 0.30, respectively. The average postoperative horizontal width ratio and vertical height ratio were 1.04 ± 0.08 and 1.01 ± 0.17, respectively There was no significant difference in horizontal width ratio or vertical height ratio before and after surgery (p = 0.314 and p = 0.087, respectively). Conclusions: Eyelid reconstruction with a direct closure can be performed without a flap or graft for 40-70% of eyelid defects when resecting the eyelid of a malignant eyelid tumor.
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