베게너 육아종증 환자에서 시행한 성공적인 내시경적눈물주머니코안연결술

최시환,이민우,이종주,이성복 대한안과학회 2015 대한안과학회지 Vol.56 No.9

목적: 베게너 육아종증 환자에게 발생한 코눈물관 폐쇄를 내시경적눈물주머니코안연결술로 치료한 1예를 보고하고자 한다. 증례요약: 내원 3년 전 베게너 육아종증을 진단 받고 rituximab 투여 뒤 현재는 안정된 상태로 azathioprine 100 mg을 복용 중인36세 여자 환자가 1년 전부터 시작된 좌안 눈물 흐름 및 고름이 차는 증상을 주소로 내원하였다. 초진 시 좌안의 눈물띠 높이가 우안에 비해 높았으며 더듬자 검사상 hard stop, 눈물소관 관류술상 점액이 역류되었고, 비강은 육아종에 의하여 중간 코선반이 관찰되지 않았다. 눈물주머니조영술에서 좌안 근위부 코눈물관 폐쇄 소견을 보였으며 안면부 3차원 단층 영상에선 좌측 눈물주머니오목에 경계가 명확한 6×5×6 mm 크기의 눈물낭종이 관찰되었다. 비강내 육아종에 대하여 유착해리술을 시행한 후 내시경적눈물주머니코안연결술을 시행하였고, 재유착을 예방할 목적으로 silastic sheet를 비중격에 봉합하였다. Silastic sheet는 2주 후, 실리콘 관은 4개월째에 제거하였다. 술 후 5개월째 좌안 눈물흘림은 없었으며, 눈물소관 관류술에서 잘 관류되었고 골공을 통해 fluorescein dye가 잘 흘러 만족할 만한 결과를 얻었다. 결론: 베게너 육아종증 환자에게 발생한 코눈물관 폐쇄에서 육아종으로 비강이 좁아져 있더라도 내시경적눈물주머니코안연결술로 치료가 가능하다고 생각된다. Purpose: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. Case summary: A 36-year-old female diagnosed with Wegener’s granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. Conclusions: Nasolacrimal duct obstruction occurring in a patient with Wegener’s granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.

실패한 눈물주머니코안연결술에서 내시경적 재개통술 시트리암시놀론을 적신 코충전물의 효과

정영훈(Young Hoon Jung),이가현(Ka Hyun Lee) 대한안과학회 2017 대한안과학회지 Vol.58 No.5

목적: 실패한 눈물주머니코안연결술 환자에서 트리암시놀론을 적신 코충전물로 내시경적 재개통술을 시행하여 효과적으로 치료한 증례가 있어 문헌고찰과 함께 보고하고자 한다. 증례요약: 4명(4안)의 환자가 코 경유 눈물주머니코안연결술 후 눈물 흘림 증상이 재발하여 내원하였다. 국소마취 후 비강 내시경하뼈 구멍 주변의 육아종과 막성 조직을 제거하였으며, 술자의 판단에 따라 부가적으로 뼈 구멍을 확장하였다. 트리암시놀론을 적신 합성스펀지(Nasopore )로 코안 충전 후 수술을 마쳤다. 실리콘관은 술 후 12주 이상 경과 관찰 후 제거하였으며, 제거 후 시행한 관류 검사 및 비강 내시경 검사에서 특이 이상 소견은 관찰되지 않았고 눈물 흘림 증상 또한 없었다. 발관 이후 6개월 이상 지속적으로 경과 관찰하였고,4명 모두에서 눈물 흘림의 재발은 없었다. 결론: 실패한 코 경유 눈물주머니 코안연결에서 내시경적 재개통술이 필요한 경우, 부가적인 트리암시놀론을 적신 코충전물 활용을 고려해 볼 수 있다. <대한안과학회지 2017;58(5):586-590> Purpose: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. Case summary: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator’s judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. Conclusions: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy. J Korean Ophthalmol Soc 2017;58(5):586-590

비내누낭비강문합술에서 Mitomycin-C의 효과

김명원,이종환,김은석,이상철,장백암,변영자 대한기관식도과학회 1998 大韓氣管食道科學會誌 Vol.4 No.2

Background and Objectives: The most common cause of the failure of endoscopic dacryocystorhinostomy is closure of the osteotomy site due to granulation or adhesion. We used mitomycin-C, an antineoplastic antibiotic agent, soaking over the osteotomy site to suppress fibrous proliferation and scar formation during the endoscopic dacryocystorhinostomy. Materials and Methods : A total of 20 Patients diagnosed with nasolacrimal duct obstruction were assigned randomly to either a mitomycin-C group or a control group. Endoscopic dacryocystochinostnmy has been used in both groups. In the mitomycin-C group, a piece of merocel soaked with 0.2 mg/ml mitomycin-C was applied to the osteotomy site and then after 30 minutes was removed. Results : All patients in the mitomycin-C group remained symptom free after removal of their silicone tube (100% success), and there were two patients in the control group who had recurrent epiphora (67% success). In the mitomycin-C group, the average surface area of the osteotomy at the end of the sixth postoperative month was 4.1 $\textrm{mm}^2$, whereas that of the control group was 2.5 $\textrm{mm}^2$. Neither serious systemic nor local toxicity were noted in the mitomycin-C group. Conclusion : Intraoperative mitomycin-C may possibly improve success rates over the endoscopic dacryocystorhinostomy procedure.

코눈물관폐쇄 수술 환자에서 눈물주머니누석의 임상병리학적 연구

최승우(Seung Woo Choi),박종서(Jong Seo Park),권아영(A Young Kwon),유혜린(Helen Lew) 대한안과학회 2016 대한안과학회지 Vol.57 No.1

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.

내시경하 누낭 비강 문합술의 임상적 고찰

이남수,전범조,조진희,윤희로 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.1

성인 코눈물관막힘에서의 눈물길미세내시경 실리콘관삽입술과 코경유눈물주머니코안연결술

정우현,이재협,김영진,양재욱 대한안과학회 2020 대한안과학회지 Vol.61 No.11

목적: 눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자에서 눈물길미세내시경 실리콘관삽입술을 시행한 경우와 코경유눈물주머니코안연결술을 시행한 경우 간의 치료 효과를 비교하고자 하였다. 대상과 방법: 눈물소관폐쇄가 없는 성인 후천코눈물관막힘 환자로 전체 50명(68안) 중 눈물길미세내시경 실리콘관삽입술을 받은 경우(21명, 31안)와 코경유눈물주머니코안연결술을 받은 경우(29명, 37안)를 후향적으로 비교하였다. 결과: 눈물길미세내시경 실리콘관삽입술을 시행한 경우 술 후 3개월 및 6개월의 성공률은 전체 31안 중 27안(87.1%), 22안(71.0%)을 보였다. 코경유눈물주머니코안연결술 환자군에서는 술 후 3개월 및 6개월의 성공률은 전체 37안 중 34안(91.9%), 30안(81.1%)을 보였다. 술 후 3개월 및 6개월의 성공률 모두 유의한 차이가 없었으나(p=0.517, p=0.327), 술 전 눈물소관관류검사에서 완전폐쇄를 보이는 경우 술 후 6개월 코경유눈물주머니코안연결술(81.8%)이 눈물길미세내시경 실리콘관삽입술(33.3%)보다 유의하게 높은 성공률을 보였다(p=0.028). 결론: 눈물소관막힘이 없는 후천코눈물관막힘 환자에서 눈물길미세내시경을 이용한 실리콘관삽입술은 환자에서 코경유눈물주머니코안연결술과 동등한 성공률을 보였으나, 코눈물관의 완전폐쇄가 있는 환자의 경우에는 낮은 성공률을 보였다. 눈물길미세내시경 실리콘관삽입술을 이용하여 불필요한 침습적 수술과 전신마취 및 합병증을 줄일 수 있을 것으로 보인다. Purpose: To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. Methods: Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. Results: For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). Conclusions: There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.

코경유눈물주머니코안연결술 시 calcium alginate와 polyurethane foam의 효과 비교

최성희,서유리,고재상,송영진,윤진숙 대한안과학회 2018 대한안과학회지 Vol.59 No.3

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. 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.

Treatment Outcomes of Endoscopic Endonasal Dacryocystorhinostomy

Kim, Hyuk,Kim, Jae-Ho,Lee, Bong-Jae Korean Rhinologic Society 1999 Journal of rhinology Vol.6 No.1

Nd:YAG 레이저와 Microdrill을 이용한 내시경적 누낭비강문합술

나경수,나한조 조선의대 1996 The Medical Journal of Chosun University Vol.21 No.2

Nd : YAG 레이저와 Microdrill을 이용한 내시경적 누낭비강문합술

나경수,나한조 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.2

Recently, with development of endoscopic surgery, different surgical lasers and surgical methods have been reported with varying success rates. Endoscopic laser lacrimal surgery can be performed as a less-invasive method than conventional lachmal surgery, but the success rates of this methods are lower than conventional methods. This technique avoided a cutaneous scar and caused less surgical trauma and bleeding than those seen in conventional lacrimal surgery, shortened postoperative recovery time and lessened postoperative pain. The use of Nd:YAG laser and microdrill assisted endoscopic dacryocystorhinostomy is minor modification in surgical technique and provided an excellent medium for surgery. Since May 1, 1995, we have successfully performed 12 cases of nasolacrimal duct obstruction with this method. We report our surgical outcomes with brief references.