작은 피부절개창과 최소박리 수술방법에 의한 위눈꺼풀처짐의 교정 = Blepharoptosis Repair by Small Cutaneous Incision and Minimal Dissection Technique

국문 초록 (Abstract)

목적: 후천성 위눈꺼풀처짐 수술 시 작은 절개와 최소박리를 통해 교정하는 간편한 수술방법을 소개하고 그 효과를 알아보고자 하였다.
대상과 방법: 작은 절개창을 통해 눈꺼풀올림근널힘줄을 찾아 단일봉합으로 교정수술을 한 위눈꺼풀처짐 환자 23명, 29안을 대상으로
후향적 연구를 시행하였다. 술 후 MRD1의 변화와 성공률, 합병증과 재수술 시행여부 등을 조사하였다.
결과: 환자의 술 전 MRD1은 평균 0.9±0.9 mm였으며, 술 후 2.7±0.8 mm였다. 단안만을 수술한 17안 중 15안(88.2%)에서 양안이
1 mm 이내의 차이를 보였으며, 양안을 수술한 12안 중 8안(66.6%)이 우수하였고, 2안(16.7%)이 좋았으며, 2안(16.7%)은 결과가 나빠
총 29안 중 25안(86.2%)에서 성공적인 결과를 얻을 수 있었다. 눈꺼풀테의 굴곡이상이 2안에서 생겼는데 모두 재수술을 시행하여 교정하
였다.
결론: 작은 절개창과 최소박리에 의한 수술방법은 고식적인 방법에 비해 비록 제한적인 환자에서만 시행이 가능하지만, 조직손상과
출혈, 부종이 적고, 짧은 수술시간과 회복기간 등의 장점을 가진 간편하고 효과적인 수술방법으로 여겨진다.

다국어 초록 (Multilingual Abstract)

Purpose: To present a simple method of acquired ptosis correction by small-incision minimal dissection technique and assess
the results of the operation.
Methods: The charts of 23 patients (29 eyes) with acquired ptosis who underwent ptosis correction by small-incision minimal
dissection technique were reviewed. Pre and postoperative MRD1, success rate, complications and reoperation rates were
investigated.
Results: The average of pre- and postoperative MRD1 were 0.9±0.9 mm and 2.7±0.8 mm respectively. Of the 17 patients who
underwent unilateral surgery, 15 eyes (88.2%) showed successful outcomes, and of the 12 eyes who underwent bilateral surgery,
8 eyes (66.6%), 2 eyes (16.7%), and 2 eyes (16.7%) showed excellent, good, and poor outcomes, respectively. Out of 29 eyes,
25 eyes (86.2%) showed satisfactory results. Two eyelids of unsatisfactory contour were corrected by reoperation.
Conclusions: Although the small-incision minimal dissection technique for ptosis correction is applicable to a restricted group
of patients compared to the conventional method, this technique is very useful and efficient, and has many advantages including
less tissue damage, bleeding, edema, a short operation time and rapid recovery.

참고문헌 (Reference)

1 이종욱, "작은 절개를 이용한 눈꺼풀처짐의 교정" 대한안과학회 49 (49): 721-726, 2008

2 문현승, "보존 대퇴근막을 이용한 변형된 크로포드법에 의한 이마근걸이술" 대한안과학회 46 (46): 10-15, 2005

3 정상기, "눈꺼풀쳐짐 환자에서 시행한 간편한 윗눈꺼풀절제술에 대한 임상연구" 대한안과학회 43 (43): 551-555, 2002

4 백세현, "눈꺼풀처짐 환자에서 일회 봉합(single suture)을 이용한 상안검거근건막 접치기술의 효과" 대한안과학회 44 (44): 1011-1016, 2003

5 Everbusch O, "Zur Operation der congenitalen Blepharoptosis" 21 : 100-107, 1883

6 Chung WS, "Treatment of ptosis. in: Ophthalic plastic and reconstructive surgery. v. 1. chap. 6" NWHS 2004

7 Jones LT, "The cure of ptosis by aponeurotic repair" 93 : 629-634, 1975

8 Baroody M, "Small incision transcutaneous levator aponeurotic repair for blepharoptosis" 52 : 558-561, 2004

9 Lucarelli MJ, "Small incision external levator repair : technique and early results" 127 : 637-644, 1999

10 Carter SR, "Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy" 103 : 623-630, 1996

11 Liu D, "Ptosisrepair by single suture aponeurotic tuck. Surgical technique and long-term results" 100 : 251-259, 1993

12 Iliff J, "Ptosis surgery. in: Duane’s clinical ophthalmology. v. 5. chap. 72" Williams and Wilkins 2001

13 Dresner SC, "Ptosis management : A practical approach. in: Oculoplastic surgery : The essentials. v. 1. chap. 6" Thieme Medical Publishers 2001

14 Bernardini FP, "Mini-invasive ptosis surgery" 25 : 111-115, 2006

15 Lee TS, "Levator function, modified Fasanella-Servat operation, ptosis degree, srugical results" 40 : 248-252, 1999

16 Frueh BR, "Efficacy and efficiency of a small incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis" 11 : 2158-2163, 2004

17 Frueh BR, "Efficacy and efficiency of a new involutional ptosis correction procedure compared to a traditional aponeurotic approach" 102 : 199-206, 2004

18 Meltzer MA, "A simplified technique of ptosis repair using a single adjustable suture" 108 : 1889-1892, 2001