임신 19 주에 선천성 후부 요도 판막 증후군 태아에서 시행된 방광 - 양막강 문합술 1 예

노정훈(Jeong Hoon Rho),박미혜(Mi Hye Park),임진섭(Jin Seob Lim),하중규(Joong Gyu Ha),오관영(Kwan Young Oh),양윤석(Yun Seok Yang),황인택(In Taek Hwang),정지학(Ji Hak Jeong),박준숙(Jun Sook Park) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

An ultrasonographic examination revealed increased fetal bladder size and decreased AFI as well as fetal bilateral hydronephrosis at 173 weeks` gestation. Diagnosis of the fetal posterior urethral valve syndrome was made. Percutaneous fetal bladder puncture with aspiration and amniocentesis was performed. The fetus was normal male karyotype and with a predicted good renal function(sodium concentration, chloride concentration, and osmolarity at 74 mEq/L, 60 mEq/L, and 148 mOsm, respectively). So, the fetus underwent amnioinfusion and vesico-amniotic shunting procedure (VASP) using a double-basket catheter at 194 weeks` gestation in order to prevent development of dysplastic kidneys and hypoplastic lungs. The healthy male baby was delivered at 384 weeks` gestation and had normally functioning kidney. Cutaneous vesicostomy was performed for the newborn since the urethral orifice was small. The one year old infant is now well and waiting for urethroscopic valve ablation procedure.

임신중 발생한 난소종양의 임상적 고찰

서정욱(Jeong Wook Seo),노정훈(Jeong Hoon Rho),오관영(Kwan Young Oh),박미혜(Mi Hye Park),김은경(Eun Kyung Kim),양윤석(Yun Seok Yang),황인택(In Taek Hwang),정지학(Ji Hak Jung),박준숙(Joon Sook Park) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : 임신 중 동반된 자궁부속기종양에 대한 임상양상 및 임신경과에 미치는 영향을 알아보고자 본 연구를 하였다.방법 및 재료 : 1995년 1월부터 1999년 12월까지 만 5년간 본원에서 경험한 임신 중 동반된 자궁부속기종양 69례를 분석하였다. 추적관찰 중 자연소멸되었거나 자궁외 임신과 동반된 경우는 제외되었다. 임상양상을 조사하였으며 임신 중 수술적 처치 및 보존적 치료가 임신경과에 미치는 영향을 분석하였다. 결과 :1. 발생빈도는 같은 기간의 총 분만수 10,550예에 69례로 1:153(0.65%)이었고 악성으로는 1예(1/10,550)의 점액성 경계성 종양이 발견되었다. 2. 연령은 25세∼29세군이 가장 많았으며(42.0%) 다산모보다 초산모에서 더 흔했다.(59.4%:40.6%)3. 난소종양으로 인한 합병증은 염전이 10예(14.6%)로 가장 많았으며 기타 출혈이나 파열의 예는 없었다.4. 진단시기는 임신 제 1삼분기가 53.6%, 제 2삼분기가 14.5%, 제 3삼분기가 31.9%였고 진단방법은 초음파와 내진에 의하였으며 제왕절개수술중 우연히 발견된 경우도 20예(29.0%)였다. 5. 수술시기는 제왕절개술중 우연히 발견된 20예를 제외하고 제 1삼분기에 67.6%, 제 2삼분기에 24.3%, 제 3삼분기에 8.1%순이었다.6. 총 69예중 제왕절개수술중 우연히 발견된 20예와 난소종양수술과 동시에 인공유산시킨 22예를 제외한 27예에서 이중 18예는 수술적 처치로 나머지 9예에서는 비수술적 요법으로 치료받으며 임신의 경과를 관찰했다.7. 임신경과는 수술적 처치를 받은 군(18예)에서 만삭질식분만이 12예(66.7%), 만삭 제왕절개수술이 5예(27.8%), 조산이 1예였으며 평균 분만주수는 38.8주였다. 비수술군(6예)에서는 만삭질식분만이 1예(16.7%), 만삭제왕절개수술이 4예(67.0%), 조산이 1예였다.8. 병리조직학적 소견으로는 양성 낭성기형종이 35.7%, 점액성 낭선종이 22.9%, 장액성 낭선종이 14.3%, 단순낭종이 14.3%였다.9. 제왕절개수술이 32예에서 행해졌는데 25례에서 산과적 이유로, 나머지 7예에서 난소종양을 주소로 수술하였다.결론 : 최근 산전진찰에 초음파의 이용으로 임신 중 자궁부속기종양의 발견율이 증가하는 추세이며 이의 처치에 있어서 임신에 미치는 영향을 고려할 때 방법의 선택에 있어 신중을 기해야 한다. 본 논문은 임신 중 자궁부속기종양의 임상양상을 조사하였으며 수술적, 비수술적 처치 및 수술시기가 임신의 경과에 미치는 영향을 비교, 분석하였다. Objective : Our purpose was to evaluate the clinical appearance and outcome of pregnancy associated with ovarian tumors. Methods : A review was performed of patients who were seen with an ovarian tumor in pregnancy from January 1995 to December 1999. We excluded ovarian tumors that resolved spontaneously and were found simultaneously with ectopic pregnancy. Results : 1. The incidence of ovarian tumors in pregnancy was 69 in 10,550 deliveries.(1:153) One case of mucinous borderline malignancy was found. 2. The ovarian tumors occuring in pregnancy were the most common at 25 to 29 years old-pregnant women(42.0%) and more common in nulliparous pregnant women(59.4%) than in multiparous women.(40.6%) 3. The most common complication of ovarian tumors in pregnancy was torsion which is 10 cases(14.6%) 4. Pre-operative diagnosis of ovarian tumors was made in the first trimester(53.6%), second trimester(14.5%), and third trimester(31.9%) 5. Excluding the 20 cases of cesarean section, operation was performed at first trimester in 25cases(67.6%), at second trimester in 9 cases (24.3%), at third trimester in 3 cases (8.1%). 6. The surgical management was performed from 18 women and the conservative therapy was done at 6 cases. 7. According to the outcome of pregnancy, among 18 cases in which the ovarian tumor was removed, vaginal delivery occurred at term in 12 cases (66.7%), cesarean section in 5 cases(27.8%) and premature delivery in 1 case. Among the other cases in which conservative management was performed, term vaginal deliveries were done in 1 case(16.7%), cesarean section in 4 cases(67.0%) and premature delivery in 1 case(16.7%). 8. The histologic features of the exised ovarian tumors were benign cystic teratoma 25 cases (35.7%), mucinous cystadenoma 16 cases(22.9%), serous cystadenoma 10 cases(14.3%) and simple cyst 10 case(14.3%) 9. The cesarean section was performed in 32 cases including emergency operation. In 25 cases, common cause was due to obstetrical problem( elective repeat cesarean section, fetal malpresentation, labor disorder) and in the rest 7 cases was due to adnexal masses. Conclusion : Although the incidence of ovarian cancer in pregnancy is low, the incidental finding of an adnexal mass in pregnancy is more common. Because complications of surgery are increased in pregnancy, operative management needs to be considered. Our data was consistent with what has been reported clinical study to determine optimal management of an ovarian tumor in pregnancy.

질식 고주파 자궁근종용해술을 이용한 자궁평활근종 및 자궁선근증의 보존적 치료에 대한 효과의 비교분석

류지훈 ( Ji Hoon Ryu ),김기환 ( Ki Hwan Kim ),박준숙 ( Jun Suk Park ),양윤석 ( Yoon Seok Yang ),오관영 ( Kwan Young Oh ),노정훈 ( Jeong Hoon Rho ),이병관 ( Byung Kwan Lee ),송영래 ( Young Rae Song ),황인택 ( In Taek Hwang ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.1

목적: 자궁평활근종 환자들과 임상증상 및 치료가 비슷한 자궁선근증 환자들의 질식 고주파 자궁근종용해술의 임상효과에 대하여 비교하고자 한다. 연구 대상 및 방법: 2005년 5월부터 2006년 5월까지 본원에서 자궁평활근종과 자궁선근증으로 진단 받은 총 108명을 대상으로 질식 고주파 자궁근종용해술을 시행하였다. 시술 전, 후 초음파를 이용하여 평활근종과 선근증의 크기, 개수, 위치 그리고 부피를 측정하였으며, 시술 후 매 방문마다 증상과 삶의 질에 대한 질문표를 사용해 호전 유무를 추적, 관찰하였다. 통계학적 유의성을 알아보기 위해 Wilcoxon signed rank test (SPSS 13.0)를 이용하였고 P값이 0.05 미만인 경우를 의미있다고 판정하였다. 결과: 질식 고주파 근종용해술을 시행 받은 76명의 평활근종 환자에서 평균 최대직경은 시술 후 1개월, 3개월, 6개월, 9개월에 각각 14.6%, 23.3%, 30.6%, 33.6%의 감소율과, 평균 부피는 각각 35.7%, 53.3%, 67.3%, 72.2%의 감소를 보였다. 또한 32명의 선근증 환자에서도 평균 최대직경은 시술 후 각각 8.9%, 13.6%, 14.6%, 11.9%의 감소율과, 평균 부피는 각각 22.6%, 30.0%, 32.3%, 28.4%의 감소를 보였다. 평활근종의 경우 증상의 중증도 (Symptom score)는 시술 전, 시술 후 각각 62.3, 52.2, 40.6, 32.6, 28.6이었고, 삶의 질 (QOL score)은 각각 68.9, 78.1, 82.9, 85.7, 87.3이었다. 선근증의 경우 증상의 중증도는 각각 77.7, 37.6, 30.6, 54.4, 67.5였고, 삶의 질은 각각 48.1, 76.5, 85.5, 66.5, 55.1이었다. 결론: 질식 고주파 자궁근종용해술은 자궁을 보존할 수 있고 비침습적이며, 근종의 크기 및 증상의 감소에 효과가 있고 바로 일상생활로의 복귀가 가능하다는 장점이 있다. 그러나 자궁선근증은 시술 후 약 6-9개월 이후 증상이 재발되는 경향을 보여 추가적인 연구 및 추적관찰을 통해 엄격한 적용기준이 마련되어야 할 것이다. Objective: To compare the clinical effectiveness of transvaginal radiofrequency myolysis of the patients with leiomyomas and the patients with adenomyosis which have similar clinical symptoms. Methods: From May 2005 to May 2006 at Eulji university hospital, 108 women who were diagnosed of leiomyoma and adenomyosis had undergone transvaginal radiofrequency myolysis. Before and after the procedure size, number of uterine myomas, location and the volume of the leiomyomas and adenomyosis were measured by ultrasound. And on every visit after the procedure improvement of the symptom was checked by questionnaire of the symptom and life quality. Using Wilcoxon signed ranked test, the statistical significance was proved and the P value lower than 0.05 was judged to be significant. Results: 76 women with leiomyoma who had undergone transvaginal radiofrequency myolysis, were followed up 1 month, 3 months, 6 months and 9 months after the procedure. The average maximal diameter of the myoma was decreased by 14.6%, 23.3%, 30.6%, 33.6% respectively, and the average volume was decreased by 35.7%, 53.3%, 67.3%, 72.2% respectively. 32 women with adenomyosis who had undergone transvaginal radiofrequency myolysis were followed up, at the same period after the procedure. The average maximal diameter of the adenomyosis was decreased by 8.9%, 13.6%, 14.6%, 11.9% respectively, and the average volume was decreased by 22.6%, 30.0%, 32.3%, 28.4% respectively. Before and after the procedure the symptom score was 62.3, 52.2, 40.6, 32.6, 28.6 respectively, and the quality of life score was 68.9, 78.1, 82.9, 85.7, 87.3 respectively in the leiomyoma group. In the adenomyosis group, before and after the procedure the symptom score was 77.7, 37.6, 30.6, 54.4, 67.5 respectively, and the quality of life score was 48.1, 76.5, 85.5, 66.5, 55.1 respectively. Conclusion: Transvaginal radiofrequent myolysis had benefits in conserving the uterus, and was less invasive, and had great effect on the reducing the size of the leiomyoma and improving the symptoms, and also returning to normal life pattern was earlier. But in women with adenomyosis the symptoms were worsened after approximately 6 to 9 months after the procedure. Therefore additional research and follow-up is required and a strict criterion is needed.

보존적 요법으로 치료한 자궁 소낭 내 감입 태반

정민 ( Min Choung ),노정훈 ( Jeong Hoon Rho ),손창업 ( Chang Up Son ),나우석 ( Woo Suk Na ),이병관 ( Byung Kwan Lee ),송영래 ( Young Rae Song ),류지훈 ( Ji Hoon Ryu ),황인택 ( In Taek Hwang ),김기환 ( Ki Hwan Kim ) 대한주산의학회 2007 Perinatology Vol.18 No.3

Uterine sacculation is a very rare complication associated with pregnancy in which a part of the uterine wall balloons, and it is difficult to diagnose because it is usually asymptomatic. It frequently contains the placenta and sometimes may be involved with the trapped placenta after delivery due to its structural characteristic. It is impossible to remove the retained placenta in the sac by using usual methods such as manual delivery or curettage so most of patients with it end up with having a laparotomy. Especially, if the placenta in it is accompanied by abnormal adherence of the placenta or serious hemorrhage, hysterectomy should be considered. Currently several conservative methods for the retained placenta including selective uterine artery embolization and administration of methotrexate have been introduced and these may be tried to treat the retained placenta in the uterine sacculation for avoiding operation and preserving future reproductive potential in selective cases. We experienced a case of placenta increta in the uterine sacculation that was diagnosed first during cesarian section and was treated with selective uterine artery embolization followed by methotrexate administration. This case is reported with a brief review of the literatures.

자궁근종의 보존적 치료를 위한 질식 고주파 자궁근종용해술

황인택 ( In Taek Hwang ),노정훈 ( Jeong Hoon Rho ),김기환 ( Ki Hwan Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.2

목적: 자궁근종의 치료에 이용한 질식 고주파 자궁근종용해술의 임상적 효과 및 안정성에 대해 분석하고자 한다. 연구 방법: 2005년 5월부터 2006년 3월까지 자궁근종의 진단 하에 본원에서 질식 고주파 자궁근종용해술을 시행 받은 67명을 대상으로 하였다. 시술 전 경복부 및 경질 초음파를 이용하여 근종의 크기, 개수, 위치 그리고 부피를 측정하였으며, 시술 후 1개월, 3개월, 6개월 후 동일인에 의해 근종의 크기 및 부피를 측정하였고. 시술 후 매 방문마다 생리과다, 생리통, 부정기 출혈 그리고 근종의 압박증상 (빈뇨, 골반통) 등의 근종 특이증상의 호전 유무를 추적, 관찰하였다. 결과: 67명 환자의 평균 연령은 42.2세였다. 근종의 평균 개수는 1.18개였고, 평균 최대직경은 5.52 cm이었으며, 평균 부피는 89.9 cm3였다. 각 근종 당 평균 시술시간은 15.1분이었고, 평균 시술횟수는 1.4회였다. 근종의 평균 최대직경은 시술 후 1개월, 3개월, 6개월에 각각 14.2%, 22.8%, 29.8%의 감소율을 보였으며, 평균 부피는 각각 34.9%, 52.5%, 63.6%의 감소를 보였다. 초기 증상이 없었거나 폐경 후인 8명을 제외한 59명 중 3개월, 6개월에 각각 45명과 37명의 증상을 확인할 수 있었다. 생리통의 증상 호전은 각각 86.7%, 82.8%를 보였고, 생리양과다는 각각 65.2%, 60%의 증상 호전을 보였다. 위의 두 가지 증상이 모두 동반된 경우에는 각각 85%와 81.2%의 증상 호전을 보였다. 시술 후 합병증으로는 일시적인 하복부 통증이 7명, 질출혈이 1명, 시술 후의 발열 및 복부 불편감으로 내과로 전과된 경우가 1명이었다. 그 외 심각한 합병증은 한 예도 없었다. 결론: 질식 고주파 자궁근종용해술은 자궁을 보존할 수 있고, 보다 비침습적이며, 근종의 크기 및 증상의 감소에 뛰어난 효과가 있어, 기존의 방법들을 대체할 수 있는 자궁근종의 치료로서 많은 효과가 있을 것으로 기대된다. Objective: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. Methods: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. Results: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. Conclusion: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.

전자간증 산모에서 산후에 발생한 난소동맥 자연파열

진찬희 ( Chan Hee Jin ),김현영 ( Hyun Young Kim ),김기환 ( Ki Hwan Kim ),노정훈 ( Jeong Hoon Rho ),오관영 ( Kwan Young Oh ),백태화 ( Tae Hwa Bek ),송영래 ( Young Rae Song ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.8

Spontaneous ovarian artery rupture is exceedingly rare case that occur in the postpartum period. There were the cases that occurred aneurysmal rupture of ovarian artery and the coronary artery rupture in the women postpartum period without preeclampsia. There were the cases that occurred the cerebral artery rupture or retinal artery rupture in preeclampsia, but ovarian artery rupture is unreported. The cause of ovarian artery rupture in the postpartum period is unknown, but we thought that thinned arterial wall may be the cause during this period. The women in preeclampsia have high risk factors such as hypertension and pathologic disorder of the vessel. The retroperitoneal hemorrhage due to ovarian artery rupture cause hypovolemic shock, eventually death, therefore, it is necessary to immediate diagnosis and treatment. We described a case of spontaneous right ovarian artery rupture that occurred 2 days after vaginal delivery in preeclampsia including a review of the literature.

질식 고주파 자궁근종용해술 후 임신에 성공하여 질식 자연분만을 시행한

김현영 ( Hyun Young Kim ),진찬희 ( Chan Hee Jin ),노정훈 ( Jeong Hoon Rho ),황인택 ( In Taek Hwang ),송영래 ( Young Rae Song ),김기환 ( Ki Hwan Kim ) 대한주산의학회 2008 Perinatology Vol.19 No.4

Radiofrequency myolysis does not require general anesthesia and is safe and effective treatment for uterine myomas tried to women in women who wish to conserve the uterus. However, a controversial issue is whether radiofrequency myolysis is safe to women who desire future pregnancies. We report a case who experienced full term spontaneous vaginal delivery without uterine rupture after radiofrequency myolysis.

Methotrexate를 이용한 보존적 치료로 성공한 유착태반

이병관 ( Byung Kwan Lee ),강경화 ( Kyung Hwa Kang ),노정훈 ( Jeong Hoon Rho ),오관영 ( Kwan Young Oh ),양윤석 ( Yoon Seok Yang ),황인택 ( In Taek Hwang ),정지학 ( Ji Hak Jung ),박준숙 ( Joon Suk Park ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.2

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though hysterectomy is a definitive therapy, there are some occasions that conservation of the uterus is desired by the patient and bleeding is not

산전초음파로 진단된 Spondylothoracic dysplasia (Jarcho-Levin syndrome)

이원진 ( Won Jin Lee ),이병관 ( Byung Kwan Lee ),조윤성 ( Yoon Seong Cho ),박미혜 ( Mi Hye Park ),노정훈 ( Jeong Hoon Rho ),오관영 ( Kwoan Young Oh ),양윤석 ( Yoon Seok Yang ),황인택 ( In Taek Hwang ),박준숙 ( Joon Suk Park ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

The Jarcho-Levin syndrome (spondylothoracic dysplasia) is a rare autosomal recessive disorder characterized by a short neck, short trunk and a constricted thorax due to multiple rib and vertebral defects. The small size of thorax in newborns frequently le

비교통성 흔적자궁 임신의 진단 및 복강경적 처치

라우석 ( Woo Suk Ra ),김기환 ( Ki Hwan Kim ),손창업 ( Chang Up Son ),정민 ( Min Choung ),노정훈 ( Jeong Hoon Rho ),황인택 ( In Tak Hwang ),박준숙 ( Joon Suk Park ) 대한주산의학회 2007 Perinatology Vol.18 No.4

A non-communicating rudimentary uterine horn is a rare Mllerian duct anomaly. We experienced a case of unruptured rudimentary uterine horn pregnancy. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudimentary uterine horn was performed. We report our case with brief review of literatures.