코눈물관폐쇄 수술 환자에서 눈물주머니누석의 임상병리학적 연구
Clinicopathological Study of Lacrimal Sac Dacryolith in Patients Treated for Nasolacrimal Duct Obstruction
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목적: 내시경적 눈물주머니코안연결술 후 발견된 눈물주머니 누석 및 눈물주머니의 병리학적 특성과 코눈물관폐쇄 환자들의 임상양상과의 상관관계를 알아보고자 한다. 대상과 방법: 2009년 8월부터 2015년 1월까지 원발성 후천성 코눈물관폐쇄로 내시경적 눈물주머니코안연결술을 시행한 158명 189안을 후향적 조사하였다. 수술 중 육안적으로 눈물주머니에서 누석이 발견되거나 병리검사상 발견된 누석이나 석회화를 눈물주머니 누석으로 정의하였다. 눈물주머니 석회화, 염증, 섬유화를 평가하고 환자 임상양상과 수술 결과, 슬라이드에서의 누석 크기 및 분포와 병리소견과의 연관관계를 분석하였다. 결과: 눈물주머니 누석은 61안(32.3%), 그중 육안상 13안(6.9%)에서 발견되었다. 17안(9.0%)에서 눈물주머니 조영술상 음영결손이 보였고 육안상 발견된 누석 기준 민감도 58.8%, 특이도 1.7%였다. 누석 크기 0.3 ± 0.8 mm2, 분포 20.1 ± 17.9%, 누석분포와 눈물주머니 염증, 섬유화는 음의 상관관계를, 누석 크기와 눈물주머니 섬유화는 음의 상관관계를 보였다(p＜0.05). 병리슬라이드상 석회화가 차지하는 비율이 50% 이상인 석회화 우세 그룹에서 그렇지 않은 그룹보다 증상 기간이 더 짧았다(p＜0.05). 수술성공률은 누석군 91.8%, 비누석군 80.5%였다(p＜0.05). 결론: 코눈물관폐쇄 환자들 중 눈물주머니 누석을 보인 경우 증상 기간이 짧고 눈물주머니 섬유화가 적었으며 수술성공률이 높았다. 따라서 코눈물관 폐쇄 중 누석을 동반한 경우에서의 누석 생성 기전과 조기치료에 대한 추가적인 연구가 필요할 것으로 생각된다.
Abstract
Purpose: To evaluate the correlation between clinical manifestation of patients with nasolacrimal duct obstruction and pathological characteristics of lacrimal sac and dacryolith found during endoscopic dacryocystorhinostomy. Methods: This retrospective study included 158 patients (189 eyes) who received endoscopic dacryocystorhinostomy. We defined lacrimal dacryolith by gross discovery in the lacrimal sac during surgery or findings during pathological examination as dacryolith or calcification, including size and distribution in pathology slides. We correlated the relationship between the patients’ clinical manifestations, surgical results, lacrimal sac's pathological findings including calcification, inflammation and fibrosis, and pathological findings of lacrimal sac dacryolith. Results: Dacryolith was found in 61 eyes (32.3%) and among them, grossly found in 13 eyes (6.9%). Dacryolith's filling defect on dacryocystography was found in 17 eyes (9.0%) and based on grossly found dacryolith, dacryocystography's sensitivity and specificity were 58.8% and 1.7%, respectively. The average size of dacryolith was 0.3 ± 0.8 mm2 with an average distribution of 20.1 ± 17.9%. Distribution of dacryolith and the proportions of inflammatory cells and fibrosis in the lacrimal sac were negatively correlated (p < 0.05). The size of dacryolith and the proportions of fibrosis in the lacrimal sac were also negatively correlated (p = 0.008). In cases where the proportion of calcification in pathology slides was over 50%, the duration of symptoms in the calcification-dominant group was shorter than in other groups (p = 0.006). The success rates of endoscopic dacryocystorhinostomy with dacryolith and without dacryolith were 91.8% and 80.5%, respectively (p = 0.046). Conclusions: The patients with lacrimal sac dacryolith in nasolacrimal duct obstruction showed shorter duration of symptoms, lower fibrosis of lacrimal sac, and higher surgical success rates than the other cases. Therefore, additional research may be necessary to determine the mechanism of dacryolith formation and early treatment in nasolacrimal duct obstruction with lacrimal sac dacryolith.
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