선천성 비루관 폐쇄에 대한 단계별 치료의 효과

목적: 선천성 비루관 폐쇄증의 연령군에 따른 단계별 병합치료 효과를 비교 분석하였다. 대상과 방법: 1996년 1월부터 2000년 12월까지 선천성 비루관 폐쇄증으로 치료를 받은 소아환자 186명(222안)을 대상으로 하였다. 연령에 따라 보존적 치료, 비루관 탐침법, 실리콘관 삽입술 등을 단계적으로 시행하였다. 초진시 환자의 연령에 따라 6개월 이하(Group 1), 7∼12개월(Group 2), 13∼24개월(Group 3), 25∼72개월(Group 4)의 4개군으로 분류하여 비교 분석하였다. 결과: 보존적 치료는 1세이하의 소아에 적용되었으며, Group 1은 75.9%, Group 2는 47.3%의 성공률을 보였다. Group 1은 Group 2에 비해 통계적으로 의미있는 결과를 보였다(p=0.0001). 1차 비루관 탐침법 후, 전체 탐침법 성공률은 Group 1은 87.9%, Group 2는 89.7%, Group 3은 80.0%, Group 4는 50.0%였고, 전체 82.6%였다. 연령군에 따른 1차 비루관 탐침법의 성공률은 통계적으로 유의성이 없었으나(p=0.208), 2차 탐침법후 전체 탐침법 성공률은 1세 이후에서 통계적으로 유의하게 감소하였다(p=0.027). 실리콘과 삽입술은 Group 1은 4안, Group 2는 3안, Group 3는 4안, Group 4는 5안 시행하였으며, 100% 성공률을 보였다. 결론: 결론적으로 186명(222안)의 선천성 비루관폐쇄에서 보존적 치료, 비루관 탐침법, 실리콘관 삽입술등의 단계별 병합치료는 그 성공률이 100%로 매우 효과적이었다. Purpose: We studied the clinical outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction(CNDO). Methods: we analyzed 186 patients (222 eyes) who had been treated for CNDO between January 1996 and December 2000. According to age, conservative treatment, nasolacrimal duct probing and silicone intubation were applied systematically until a successful outcome was achived. Patients were grouped according to their age at the time of first visit: Group 1 (0∼6 months), Group 2 (7∼12 months), Group 3 (13∼24 months), Group 4 (25∼72 months). Treatment efficacy was determined according to age and success rate was compared. Results: Conservative treatment was applied only in children less than 1 year of age and was successful in 75.9% of Group 1 and 47.3% of Group 2. The difference between these two success rates was significant (p=0.0001). The overall success rate for first probing in all groups was 65.2% with a range 75.8% in Group 1, 62.1% in Group 2, 65.0% in Group 3, and 40.0% in Group 4. After second probing, the overall cure rates for the entire cohort were 82.6% with a range 87.9% in Group 1. 89.7% in Group 2, 80.0% in Group 3, and 50.0% in Group 4. There was no real difference in first probing cure rate relative to age (p=0.208). But after second probing, overall cure rate was signigicantly decreased when the age of the patients was over 12 months (p=0.027). Silicone intubation was performed in 4 of Group 1,3 of Group 2,4 of Group 3, and 5 of Group 4 and was successful in all cases. Conclusions: Systematic treatment approach to CNDO including conservative treatment, nasolcrimal duct probing, and silicone intubation, was highly successful. In this