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김주명 ( Joo Myung Kim ),심규민 ( Kyu Min Shim ),이원식 ( Won Sik Lee ),이금정 ( Keum Jung Lee ),최준식 ( June Seek Choi ),허걸 ( Kuol Hur ),정상희 ( Sang Hee Jung ),신중식 ( Chung Sik Shin ),안현경 ( Hyun Kyong Ahn ),한정렬 ( Ju 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9
목적 : 임신중에 진단된 자궁부속기 종양의 수술적 처치의 안전성과 시기 그리고 수술 후 임신에 미치는 영향을 알아보고자 하였다. 연구 방법 : 1996년 1월부터 2001년 12월까지 임신중에 진단된 자궁부속기 종양에 대해 수술적 처치를 시행한 171명을 대상으로 그 결과를 후향적으로 분석하였다. 종양의 성상, 수술 적응증 그리고 수술 시기 등이 임신예후에 미치는 영향들을 진료기록을 검토하여 비교분석하였다. 예후가 불량한 임신결과는 조기 분만, 자궁내 태아사망, 자연 유산, 주산기 사망으로 정의하였다. 통계학적 분석은 SPSS에 의한 t-test와 Fisher`s exact test를 이용하였다. 결과 : 임신중 수술을 필요로 하였던 자궁부속기 종양의 발생빈도는 292.3분만당 1이였다. 악성이나 경계성 악성종양은 12예로서 7%를 차지하였다. 43예의 응급수술중에서 31예 (72%)가 염전으로 인하여 수술을 시행받았다. 18예의 예후가 불량한 임신결과가 있었으며, 자연유산 3예, 자궁내 태아사망 1예, 조기분만이 14예 이었다. 응급으로 수술을 시행한 경우가 선택적 수술을 시행한 경우보다도 더 많은 예후불량의 임신 결과를 보였으며 (11/43 [25.6%], 7/118 [5.9%] P=.001), 임신 20주 이후와 20주 이전에 수술이 시행된 경우를 비교해 보았을 때 임신 20주 이후에 수술이 시행된 경우 조산을 비롯한 예후 불량의 임신결과가 더 많았다 (6/16 [37.5%], 12/145 [8.3%] P=.004). 결론 : 임신중 진단된 자궁부속기 종양 중에서 수술의 기준이 되는 경우에는 임신 제2삼분기 초반에 사전 계획된 선택적 수술을 시행하는 것이 향후에 발생할 수 있는 종양의 합병증 (염전, 파열 등)으로 인한 응급수술을 예방하고 악성 종양의 진단이 늦어져서 생길 수 있는 위험성을 감소시켜 산모와 태아에게 미칠 수 있는 영향을 최소화 할 수 있다. Objective : The objective of this study was to evaluate the safety and timing of the surgery and fetal outcome of pregnancy complicated by a persistent adnexal mass that was required surgical intervention Methods : We retrospectively reviewed 171 cases of adnexal masses during pregnancy that were required surgery at Samsung Cheil Hospital & Women`s Healthcare Center between 1996 to 2001. We analysed medical records for characteristics of tumor, indication and timing of surgery and the effect of pregnancy outcome. Adverse pregnancy outcome is defined as preterm delivery, spontaneous abortion, intrauterine fetal death and perinatal death. The obtained data were analysed using t-test and Fisher`s exact test by SPSS. Results : The incidence of adnexal masses during pregnancy that required surgical management was 1 in 292.3 live births. A malignant tumor or a tumor of low malignant potential was found in 7% of cases. A total of 43 patients underwent surgery under emergency condition, 31 (72%) of which were done due to torsion. There were 14 preterm delivery, 3 spontaneous abortion, 1 intrauterine fetal death, 1 perinatal death and 2 artificial abortion in this study. There was a significant difference in adverse pregnancy outcome between elective and emergency group (7/118 [5.9%] versus 11/43 [25.6%] P=.001), and surgery group that before 20 week`s gestation and those of after 20 week`s gestation (12/145 [8.3%] versus 6/16 [37.5%] P=.004). Conclusion : When necessary and feasible, surgery should be scheduled for the early portion of the second trimester, when organogenesis is complete and most spontaneous abortion have occurred, but before later risks of technical difficulties and premature labor. Also we recommend early diagnostic evaluation and immediate surgical intervention of adnexal masses as problematic adnexal mass diagnosed during pregnancy to prevent the risk of emergency surgery associated with adnexal complication (torsion, rupture and hemorrhage) and the risk of delayed diagnosis of malignancy.
김미라 ( Mi La Kim ),이원식 ( Won Sik Lee ),조연진 ( Joo Myung Kim ),김주명 ( Yeon Jean Cho ),주관영 ( Kwan Young Joo ),최규홍 ( Kyu Hong Choi ),이인국 ( In Kook Lee ),김재준 ( Jae Joon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11
목적: 질식 자궁적출술을 시행받은 환자에서 수술이 질 길이에 미치는 영향에 대해 알아보고자 하였다. 연구 방법: 38개월의 기간 동안 한 명의 수술자에 의해 질식 자궁적출술을 시행 받은 환자 155명을 대상으로 연구를 하였다. 질식 자궁적출술시 질원개 탈출을 예방하기 위해 자궁천골인대의 상방 1.0~1.5 cm 부위와 질끝단을 재차 봉합하는 방법을 사용하였다. 환자의 임상적 특징 및 측정된 수술 전후의 질 전체 길이를 후향적으로 분석하였다. 결과: 술전에 측정된 평균 질 전체 길이는 7.32±0.84 cm였다. 수술 2개월 후, 평균 질 전체 길이는 7.42±0.77 cm로 길어졌으며 통계학적 유의성을 보였다 (P=0.045). 155명의 환자 중 81명은 술후 5개월에서 12개월 사이에 질 전체 길이가 다시 측정되었으며, 이들에서의 질 전체 길이는 술전과 비교하여 의미 있게 증가하였다 (7.3±0.82 cm vs 7.48±0.78 cm, P=0.011). 1년 이상의 기간이 지난 후에 다시 질 전체 길이가 측정된 환자는 30명이었으며, 이들에서도 질 전체 길이는 술전에 비해 의미 있는 증가를 보였다 (7.17±0.81 cm vs 7.46±0.66 cm, P=0.006). 결론: 질식 자궁적출술 후의 질 전체길이는 임상적인 의미는 미미하지만, 통계학적으로는 의미있는 증가를 보인다. Objective: The purpose of this study was to evaluate the impact of vaginal hysterectomy on total vaginal length (TVL). Methods: Retrospective analysis of 155 medical records of patients underwent vaginal hysterectomy by one surgeon with benign uterine pathology in the absence of prolapse between January 2004 and February 2007. After hysterectomy, uterosacral vaginal vault resuspension (anchoring to vaginal vault about 1.0~1.5 cm proximal at the ligament) was performed for prevention of vault prolapse. Patients` characteristics and TVL before and after surgery were evaluated. Results: Preoperative mean TVL was 7.32±0.84cm. At two months after the surgery, mean TVL was 7.42±0.77 cm. The change of vaginal length was statistical significance (P=0.045). Eighty-one patients were reevaluated at five to twelve months after surgery, mean TVL was longer than the preoperative results (7.3±0.82 cm vs 7.48±0.78 cm, P=0.011). We evaluated 30 patients who were followed at least 12 months after the surgery, the length was longer than the preoperative results, also (7.17±0.81 cm vs 7.46±0.66 cm, P=0.006). Conclusion: Although that appears to be statistically significant elongation of the total vaginal length after vaginal hysterectomy, the impact is unlikely to be clinically significant.
GnRH agonist 사용 중 심한 자궁출혈 환자에서의 자궁의 모세혈관확장증
김미라 ( Mi La Kim ),김주명 ( Joo Myung Kim ),이원식 ( Won Sik Lee ),주관영 ( Kwan Young Joo ),이인국 ( In Kook Lee ),김혜선 ( Hye Sun Kim ),홍성란 ( Sung Ran Hong ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.1
Telangiectasis of the uterus is an extremely rare but life-threatening disease because of massive uterine bleeding. The usage of GnRH agonist can cause regression and atrophy of the endometrium through induction of hypoestrogenism by pituitary down-regulation. But there is no clear explanation or report in the literature showing the relationship between uterine telangiectasis and GnRH agonist usage. We have experienced a patient with uncontrolled massive uterine bleeding after GnRH agonist treatment, who needed emergency hysterectomy. Pathologic tissue examination showed telangiectasis of the endometrium and myometrium. This is the first case report of telagiectasis of the uterus without other organ involvement. We report this case with a brief review of the literatures.
김경연 ( Kyung Yeon Kim ),유원식 ( Won Sik Yoo ),김남숙 ( Nam Sook Kim ),조수희 ( Soo Hee Jo ),주관영 ( Kwan Young Joo ),김주명 ( Joo Myung Kim ),홍성란 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.12
Hemangiomas of ovary are extremely rare tumors, although ovaries have a very rich vasculature. There are only approximately 50 cases of ovarian hemangioma reported in the literature. The most of ovarian hemangiomas are the cavernous type and may present either as isolated unilateral ovarian masses, which are discovered incidentally, or together with diffuse abdominopelvic hemangiomatosis. We report a case of a ovarian hemangioma discovered incidentally in a 35-year-old woman with brief review on this topic.
자궁경수술로 성공적으로 치료된 점막하 낭성자궁선근종 2예
김남숙 ( Nam Sook Kim ),김주명 ( Joo Myung Kim ),김미라 ( Mi La Kim ),이시원 ( Si Won Lee ),주관영 ( Kwan Young Joo ),김혜선 ( Hye Sun Kim ),김희숙 ( Hy Sook Kim ),홍성란 ( Sung Ran Hong ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2
Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.