자궁부속기 종양을 가진 폐경기 환자에서 선택적 복강경 수술에 관한 연구

박창수,강선영,엄상탁,배덕수,이제호 대한산부인과내시경학회 2000 대한산부인과내시경학회잡지 Vol.12 No.1

자궁 경부 암에서 유식세포분석에 의한 DNA 양상과 임상적 특성과의 상관관계

강선영,배덕수,엄상탁,박창수,이제호 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.4

Objective: Flow cytometric deoxyribonucleic acid (DNA) content analysis has been shown to be of prognostic importance in some cancers. In this study, DNA patterns obtained by flow cytometry in patients with cervical cancer have been shown to be related to a prognostic importance in cervical carcinoma. Methods And Materials: We retrospectively reviewed 59 cervical cancer patients who admitted to the department of obstetrics and gynecology, Samsung Medical Center from January 1995 to May 1997. Results: A total of 59 archival paraffin-embedded blocks were proc 42.4 percent were found to be DNA content aneuploid (DNA-A) and 57.6 percent DNA content diploid (DNA-D). The S-phase fraction was significantly increased with stage. The incidences of aneuploid and relative DNA index were not significantly increased with the stage(P=0.280) and age of patients(P=0.088). The results had no significant differences between the squamous cell carcinoma and adenocarcinoma, and no relationship between the groups with keratinizing cell type and nonkeratinizing type(P=0.409). The DNA ploidy patterns were not significantly correlated with metastasis to lymph node(P=0.179), tumor size(P=0.109), invasion depth(P=0.361) and recurrent group(P=0.285). High S-phase fraction had a tendency to correlate with the invasion depth(P=0.011), size(P=0.027), lymph node metastasis(P=0.039) and recurence(P=0.099) of cervical cancer. Conclusion: Flow cytometric DNA content analysis is being used more frequently in the management of different malignant tumors. Our study shows that DNA content analysis may not serve as an important biological indicator in determining the prognosis in cervical carcinoma, but High S-phase fraction has been connected with more aggressive tumors.

호르몬 치료 받지않은 터너증후군에서의 자궁내막암

차경봉(Kyong bong Cha),엄상탁(Sang Tak Um),이은주(Eun Ju Lee),오상윤(Sang Yun Oh),이지수,박창수(Chang Soo Park),배덕수(Duk Soo Bae),이제호(Je Ho Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

The patients with Turner syndrome are unlikely to develop endometrial carcinoma unless they have received unopposed estrogen replacement therapy. This case describes a 21-year-old woman with Turner syndrome who developed adenocarcinoma of the endometrium without having received hormone replacement. The patient showed typical Turner's phenotype and analysis of karyotype revealed 46,X, i(Xq) (isochromosome X). Secondary sexual development had been seen until age 19 and she had no history of hormone replacement therapy(HRT). Vaginal bleeding was the presenting symptom. This seems to be the first report of the occurrence of endometrial carcinoma in an isochromosome X patient without estrogen replacement therapy (HRT) in Korea. The etiology of this rare case may be an increased propensity for patients with X-chromosome deletions to develop neoplasms in general, or extragonadal estrogen production.

임신과 동반된 난관기형종 1 례

정기성,문용호,김안택,엄상탁,정자영 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.4

저자들은 30세 여자 환자에서 임신과 동반된 왼쪽 난관 양성기형종 1례를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다. Teratoma of the Fallopian Tube is very rare. A case of the mature cystic teratoma was noted incidentally in a patient who was undergoing cesarean section for placenta previa. Diagnosis was made on the basis of the post-partial salpingectomy biopsy findings. Here we present the case with a brief history and review of the literatures.

쌍태 중 정상아와 동반된 무뇌아 1 예

정기성,정정은,이대원,엄상탁,전현욱,심주현 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

A case of anencephaly associatied with twin pregnancy that delivered by primary lo-wer flap transverse cesarean section at 35-weeks of gestation is presented with brief revi-ew of literatures.

난소의 악성 혼합성 뮬러리안 종양 1예

오성희,배덕수,노정수,최세미,엄상탁,박창수,이제호 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.3

Malignant mixed mu¨llerian tumors(MMMTs) are uncommon neoplasms of the female genital tract that are histologically defined by the presence of malignant epithelial and stromal elements. MMMTs can arise hom the uterine body, cervix, vagina, ovary, and fallopian tube and constitute less than 1% of all overian malignancies. These tumors are usually advanced when diagnosed and follow an aggressive clinical course. We had experienced a case of MMMT of the ovary and presented with a brief review of literature.

대망에서 발견된 염전 분리된 난소낭성 기형종 1 예

정기성,정정은,이대원,엄상탁,전현욱,강성수,지병주 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

While ovarian cystic teratoma is one of the most common ovarian neoplasms, benign cystic teratoma of the omentum is a rare tumor. A 39 years old women was admitted for lower abdominal pain. Abdominal and pelvic examination revealed a goose egg sized mass in the left side of cul de sac. Ultrasonography showed 5×7 cm sized, ill-defined mixed echogenecity mass in cul de sac. At laparotomy, a 6.5×4.5×2 cm mass was found in the pelvic cavity with relation to right ovary. A 6.8×5×3.5 cm sized mass was found in the pelvic cavity, attached to the greater omentum with adhesion to the left side of cul de sac. Pathologic examination revealed typical findings for cystic teratoma in both sided lesions. We recently experienced a case which suggest mechanical separation of dermoid cyst from ovary by torsion and reported here with brief review with literautres.

미세수술을 이용한 난관복원 수술후 임신율에 대한 임상적 고찰

정기성,박경도,김안택,박성운,이대원,엄상탁 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.9

1990년 1월부터 1994년 12월까지 마산고려병원산부인과 불임센타에 난관복원술을 받기 위하 여 입원한 환자 201명중 6개월이상 추적조사된 166명을 대상으로 다음과 같은 결과를 얻었다. 1. 대상환자의 평균연령은 33.1세(26-44세)이었고 30-34세사이가 59.1%로 과반수 이상을 차지하였다. 2. 복원수술의 동기는 심경에 의한 마음의 변화가 45.8%로 가장많았고 재혼의 경우는 41.0% 였다. 3. 과거에 시술을 받었던 불임수술의 종류는 복강경불임수술이 94.6%로 대부분을 차지하였고 그 중에서도 전지소작법이 현저히 많았다. 4. 시행된 복원수술을 난관 부위별로 보면 협부-팽대부 문합이 48.2%, 협부-협부문합이 63.8% 자궁각-협부문합이 13.9%순이었다. 5. 난관복원술의 술식에 따른 임신성공율은 협부-협부문합이 77.1% 협부-팽대부문합이 634.8%, 팽대부-팽대부만합이 62.5%순이었다. 6. 수술후 난관의 길이는 5cm이상이 71.7%, 4.9cm이하기 28.3%이엇다. 7. 복원수술후 난관의 길이에 따른 임신성공율은 3-4.9cm의 경우가 53.2% 5-6.9cm인 경우가 68.3% 7-8.9cm의 경우가 75.0%였다. 8. 임신된 108예에 있어서 복원수술 후부터 임신까지의 기간은 12개월 이내에 66예로서 가 장 많았고, 13-24개월이 31예, 25-36개월이 10예, 37개월이상에서 1례를 보였다. 9. 임신의결과는 만삭분만이 81예, 현재 임신중인 경우가 6예, 자궁외임신의 경우가 8예, 자 연유산인 경우가 11예, 조기분만이 2예이었다. From January 1990 through December 1994, 166 patients(mean age 33.1 yrs) who underwent a microsurgical tubal reversal of the fallopian tubes in the Department of Obstetrics and Gynecology, Masan Samsung Hospital were reviwed in order to determine the pregnancy rate and to evaluated the influencing factors. The result were as follows; 1. The mean age of the patients wa 33.1years(26-44 yrs) and 76.1 years of the patients had zero or 1 child at the time of operation. 2. The reasons for requesting tubal reversal were change of attitude(45.8%) remarriage(41.0%), loss a children (13.2%). 3. The distributions of the site of tubal anastomosis were isthmic-ampullar 48.2% isthmic-isthmic 28.9% cornual-isthmic 13.9%. 4. The postoperative tubal length was 5.0cm or more in 71.7% 5. The result of the pregnancy outcome among the 166 cases was 81 term delivery, 6 pregnancy state, 8 ectopic preg, 11 spontaneous abortion.

LHRH맥동성 투여에 의한 불임증의 치료

정기성,문용호,박경도,정정은,오대출,엄상탁,정자영 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.10

1989년 8월부터 1992년 9월까지 본원에서 불임증치료를 위해 LHRH동맥성 주입펌프를 사용 하였는데 모든 환자에서 투여경로는 정맥투여로 했으며, 큰부작용은 없었다. 투여량은 환자 10예에서 모두 20 ug/pulse 였으며 90분 간격으로 투여하였다. 환장 10예에서의 임상적결과는 다음과 같다. 1. 배란율은 76.5%였고, 임신율은 38.5%로 다른 연구에서와 유사하였다. 2. 과배란은 2cycles(11.8%)로 발생하여 다른 보고에서 보다 높은 과배란을 보였는데 이것은 HMG동시 투여에 의한 것을 보여진다. 3. 쌍태아는 1예에서 있었으며 자연유산은 1예 있었다. 성선기능저하증이나 고프로락틴증으로 인한 불임환자에서 LHRH 주입펌프의 사용은 매우 효과적이고 안전한 방법으로 보여지며, 그외 다른 요인으로 인한 불임환자에서 이전의 약물로서 배란이 실패하였던 경우 LHRH 지속적 주입법이 치료의 적응은 되지만 본원 환자에서 는 배란성공율이 높지 않았으며 큰 효과가 없었다. 그러나 대상환자가 10예에 불과하여 충분한 결과는 얻지 못하였으며 앞으로 보다 많은 환자를 대상으로 한 연구가 있어야 할 것이다. The effects of pulsatile LHRH therapy have been studied for the treatment of different cause of infertility. This report is to review the records of 10 patients who visited to out infertilty clinics for the infertility management with pulsatile LHRH regimen from Augest 1989 to September 1992 retrospectively. LHRH was admimistered intravenously in a dose of 20 ug per pulse every 90 minutes with the pulsatile infusion pump. With LHRH therapy ovulation induced in 76.5% of the patients, Four patients became pregnant. The conclusion reached that pulsatile administraion of LHRH can be a therapeutic tool in the treatment of infertility in women who have an insufficient endogenous release of LHRH or failed with other regimens.

자궁비대가 있는 여성에서의 질식자궁적출술

정철권 ( Chul Gwon Chung ),주장오 ( Jang Oh Joo ),김창운 ( Chang Woon Kim ),엄상탁 ( Sang Tak Eum ),박경도 ( Kyung Do Park ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.6

목적 : 본 연구의 목적은 질식자궁적출술을 시행함에 있어 자궁무게와 수술성적간의 관계를 평가함으로서 자궁비대가 있는 여성에서의 질식자궁적출술의 안전성과 효율성을 밝히고자 함에 있다. 연구 방법 : 2001년 2월부터 2003년 11월까지 본원에서 질식자궁적출술을 시행한 170명의 환자들을 자궁 무게가 300 gm에서 1000 gm 사이인 40명 (Group I)과 자궁무게가 300 gm 미만인 130명 (GroupsII)으로 나누어 분류하여, 각각 의무 기록지를 통해 연령, 분만력, 자궁무게, 수술기왕력, 동반수술, 수술 후 입원기간, 출혈량, 수술 전 후 헤모글로빈 변화, 수술시간, 합병증을 비교분석 하였다. 결과 : 임상적 분석의 결과 두 집단간의 연령, 분만력, 수술기왕력, 수술 후 입원기간, 동반수술, 출혈량, 수술 전 후 헤모글로빈 변화 비교에서는 유의한 차이가 없었으며, 수술 합병증 발생률의 비교에서도 Group I에서 12.5%, GroupII에서 13.1%로 유의한 차이는 없었다 (p=.660). 수술시간의 비교에서는 Group Ido서 GroupII에서 보다 평균 16분 가량 수술시간이 더 소요되었으나 통계학적 유의성은 없는 것으로 나타났다 (Group I 78.4±27.1분; GroupII 62.9±22.7분) (p=.176). 결론 : 자궁무게가 300 gm과 1000 gm 사이로 자궁비대가 있는 여성에서의 질식자궁적출술은 자궁무게가 300 gm 미만인 경우와 비교하여 안정성 및 효율성에 차이가 없었으며, 자궁비대가 질식자궁적출술의 금기증이 되지 않으며, 자궁세절술 (morcellation)을 능숙하게 사용함으로서 수술시간을 줄일 수 있을 뿐 아니라 더욱 안전하게 질식자궁적출술을 시행할 수 있을 거라 사료된다. Objective : The purpose of this study was to evaluate the relationship between uterine size and surgical outcomes in women undergoing total vaginal hysterectomy. Methods : We revieres the medical records of the 170 patients who underwent total vaginal hysterectomy from February 2001 to November 2003. These patients were stratified into two groups; Group I, patients with uterine weight of between 300 gm to 1000 gm; GroupII, patients with uterine weight of <300 gm. The two groups were compared for ages, parity, uterine weight, previous abdominal operations, concurrent surgical procedures, postoperative discharge day, bleeding amount, perioperative hemoglobin concentration change and operative time. Results : 1. There were no significant difference between the two groups with respect to postoperative discharge day, concurrent surgical procedures, bleeding amount and perioperative hemoglobin concentration change. 2. The rate of surgical complications were similar in the two group (Group I 12.5%; GroupII 1301%) (p=.660). 3. Operative time for vaginal hysterectomy was slightly longer for women in Group I than Group II (Group I 78.4±27.1 minutes; GroupII 62.9±22.7 minutes) (p=.176), but the difference between the two groups in operative time was not statistically significant. Conclusion : The vaginal hysterectomy is as safe and effective for the woman with enlarged uterus (300-100 gm) as for the woman with uterine weight of <300 gm. Uterine enlargement (Uterine weight>300 gm) is not an absolute contraindication to vaginal hystrectomy.