Eksternal dakriyosistorinostomi ameliyatında W şeklinde cilt kesisi
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Date
2010
Authors
Ayvaz, Ayşe Tör
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu prospektif, randomize çalışmada, primer edinsel nazolakrimal kanal tıkanıklığı (NLKT) nedeniyle eksternal dakriyosistorinostomi (DSR) ameliyatı yapılan hastalarda dikey-düz ve "çift V" şeklindeki cilt kesileri postoperatif cilt izi açısından karşılaştırıldı.Bu çalışma, Temmuz 2006 - Kasım 2008 arasında Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı'nda, primer eksternal DSR yapılan, edinsel NLKT'li 88 hastayı (74 kadın, 14 erkek; yaş aralığı: 18-55 yıl; ortalama yaş: 41.66±9,8 yıl) içerdi. Her bir hastanın tek gözü çalışmaya dahil edildi. Randomize biçimde 43 hastada dikey-düz kesi, 45 hastada "çift V" kesi yapıldı.Ameliyattan sonra 3. ve 6. aydaki izlem muayenelerinde çeşitli cilt skarı bulgularının (hiperemi, hipertrofi, hipopigmentasyon ve epikantal katlantı) var olup olmadığı kaydedildi. Aynı muayeneler sırasında hastaların oblik yüz fotoğrafları çekildi. Bu fotoğraflar 3 bağımsız gözlemci tarafından değerlendirildi. Aynı şekilde ameliyattan sonra 6. ayda hastaların cilt izine ilişkin görüşleri ve ameliyat sonucundan memnun olup olmadıkları kaydedildi. Bağımsız gözlemciler ve hastalar cilt izini 0'dan 4'e kadar derecelendirdi.Gözlemci yorumlarına göre hem 3. hem de 6. ayda "çift V" grubundaki cilt izi, düz kesi grubundaki cilt izinden anlamlı ölçüde daha azdı (P<0.001, P=0.001, Mann-Whitney U testi). Hasta yorumlarına göre ameliyattan sonra 6. ayda skar belirginliği "çift V" grubunda, düz kesi grubuna kıyasla anlamlı ölçüde daha azdı (P=0.003, Mann-Whitney U test).Üçüncü ayda, epikantal katlantı dışında tüm skar bulguları (hiperemi, hipertrofi, hipopigmentasyon) "çift V" grubunda, düz kesi grubuna kıyasla anlamlı ölçüde daha azdı (P=0.034, P<0.001, P=0.002, Pearson ki-kare test). Altıncı ayda hipopigmente çizgi "çift V" grubunda düz kesi grubundan anlamlı ölçüde daha azdı (P<0.001, Fisher'in kesin ki-kare testi). Düz kesi grubunda 3. ayda 2 hastada, 6. ayda 1 hastada epikantal katlantı görüldü, "çift V" grubunda epikantal katlantı görülmedi.Ameliyattan sonra 6. ayda ameliyat başarısı ve hasta memnuniyeti açısından iki kesi grubu arasında istatistiksel olarak önemli fark yoktu (P=1.0, P=0.429, Fisher'in kesin ki-kare testi).
In this prospective, randomized study, straight-vertical and “W” shaped skin incisions in patients with primary acquired nasolacrimal duct obstruction (PANDO), who undergone external dacryocystorhinostomy (DCR), were compared for the visibility of postoperative skin scar. This study included 88 patients with PANDO undergoing primary external DCR (74 females, 14 males; age range: 18-55 years; average age: 41.66±9.8 years) at Uludag University Faculty of Medicine Department of Ophthalmology between July 2006-November 2008. One eye of each patient was included in the study. A straight-vertical skin incision in 43 patients, “W” shaped skin incision in 45 patients were performed in a random fashion. We recorded whether there were certain skin scar findings (hyperemia, hypertrophy, hypopigmentation and epichantal fold) or not during the follow up examinations in 3 and 6 months after the surgery. During these examinations, oblique facial photographs of the patients were taken. These photographs were evaluated by three independent observers. We also recorded the patients opinion on the result of the surgery and apparance of the skin scar. The observers and patients graded postoperative skin scar from 0 to 3; 0 being no visible scar and 3 being very obvious scar. According to the observers comments, the scar visiblity, in both the 3rd and the 6th months visits, was significantly less in the “W” group compared to that of the straight incision group (P<0.001, P=0.001, U test of Mann-Whitney). According to the patients, the prominence of the skin scars, at the 6th month visit was significantly less in the “W” group compared to in the straight incision group (P=0.003, Mann-Whitney U test). In the 3rd month, all scar findings except epichantal fold (hyperemia, hypertrophy, hypopigmentation) were significantly less in the “W” group compared to the straight incision group (P=0.034, P<0.001, P=0.002, X square test of Pearson). In the 6th month, hypopigmented line was significantly less in the “W” group compared to the straight incision group (P<0.001, exact X square test of Fisher). Epichantal fold occured in 2 patients in the straight incision group, in the 3rd month, and in 1 patient in the 6th month, but none occured in the “W” group. In postoperative 6th month, there were no significant differences between the two incision groups for surgical succes and patient satisfaction (P=1.0, P=0.429, exact X square test of Fisher).
In this prospective, randomized study, straight-vertical and “W” shaped skin incisions in patients with primary acquired nasolacrimal duct obstruction (PANDO), who undergone external dacryocystorhinostomy (DCR), were compared for the visibility of postoperative skin scar. This study included 88 patients with PANDO undergoing primary external DCR (74 females, 14 males; age range: 18-55 years; average age: 41.66±9.8 years) at Uludag University Faculty of Medicine Department of Ophthalmology between July 2006-November 2008. One eye of each patient was included in the study. A straight-vertical skin incision in 43 patients, “W” shaped skin incision in 45 patients were performed in a random fashion. We recorded whether there were certain skin scar findings (hyperemia, hypertrophy, hypopigmentation and epichantal fold) or not during the follow up examinations in 3 and 6 months after the surgery. During these examinations, oblique facial photographs of the patients were taken. These photographs were evaluated by three independent observers. We also recorded the patients opinion on the result of the surgery and apparance of the skin scar. The observers and patients graded postoperative skin scar from 0 to 3; 0 being no visible scar and 3 being very obvious scar. According to the observers comments, the scar visiblity, in both the 3rd and the 6th months visits, was significantly less in the “W” group compared to that of the straight incision group (P<0.001, P=0.001, U test of Mann-Whitney). According to the patients, the prominence of the skin scars, at the 6th month visit was significantly less in the “W” group compared to in the straight incision group (P=0.003, Mann-Whitney U test). In the 3rd month, all scar findings except epichantal fold (hyperemia, hypertrophy, hypopigmentation) were significantly less in the “W” group compared to the straight incision group (P=0.034, P<0.001, P=0.002, X square test of Pearson). In the 6th month, hypopigmented line was significantly less in the “W” group compared to the straight incision group (P<0.001, exact X square test of Fisher). Epichantal fold occured in 2 patients in the straight incision group, in the 3rd month, and in 1 patient in the 6th month, but none occured in the “W” group. In postoperative 6th month, there were no significant differences between the two incision groups for surgical succes and patient satisfaction (P=1.0, P=0.429, exact X square test of Fisher).
Description
Keywords
Primer edinsel nazolakrimal kanal tıkanıklığı, Eksternal dakriyosistorinostomi, Cilt izi, Postoperatif komplikasyon, Primary acquired nasolacrimal duct obstruction, External dacryocystorhinostomy, Skin scar, Postoperative complication
Citation
Ayvaz, A. T. (2010). Eksternal dakriyosistorinostomi ameliyatında W şeklinde cilt kesisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.