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.

산전에 진단된 단일 제대동맥태아에서 동반기형 및 주산기예후에 관한 연구

박미혜(Mi Hye Park),오관영(Kwan Young Oh),양윤석(Yun Seok Yang),황인택(In Taek Hwang),박준숙(Joon Suk Park) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.8

목적 : 산전에 진단된 단일 제대동맥태아에서 동반기형, 염색체이상 및 주산기예후를 살펴보고, 소실된 제대동맥의 위치에 따른 동반기형 및 염색체이상빈도의 차이를 알아보고자 본 연구를 시행하였다. 대상 및 연구 방법 : 1998년 3월부터 2001년 5월까지 대전 을지대학병원 산부일과에서 산전초음파검사상 단일 제대동맥이 진단되고 추적 관찰된 쌍태아임신 1예를 포함한 30예를 내상으로 하였으며 초음파 소견 및 의무기록를 토대로 소실된 제대동맥위치, 동반기형, 염색체이상, 주간기예후를 조사하였다. 결과 : 전체 30예 중 11예 (36.7%)가 동반기형이나 염색체이상으로 임신중절을 하였고 2예 (6.7%)는 각각 무뇌수두증, 복합염색체기형으로 분만 후 사망하였다. 성별이 확인된 단일 제대동맥태아에서 남녀의 비는 1:1.6 이었다. 전체 30예 중 동반기형은 17예 (56.7%)에서 발견되었으며 심혈관계 기형 9예 (30.0%), 비뇨생식계 6예 (20.0%), 중추신경계 5예 (16.7%,), 근골격계 4예 (13.3%), 위장관계 2예 (6.7%) 및 흉벽결손 1예 (3.3%) 순이었고, 이중 7예 (23.3%)에서 한가지 장기 이상의 다발성 기형을 동반하였다염색체검사가 시행된 25예 중에서 5예 (20.0%)에서 염색체이상이 확인되었으면 염색체이상이 확인된 태아는 모두 산전 초음파검사에서 단일제대동맥 이외의 다른 장기기형이 동반되었다. 동반기형 및 염색체이상이 없는 단일 제대동맥태아는 13예였으며 이중 3예 (23.1%)에서 자궁내성장부진을 보였으며 3예 (23.1%)에서 비정상적 태위로 제왕절개술이 필요하였다. 소실된 제대동맥의 위치가 확인된 26 예중 13예 (50%)는 우측 제대동맥이, 13예 (50%)는 좌측 제대동맥의 소실을 보였고, 소실된 제대동맥위치에 따른 동반기형 및 염색체이상의 빈도차이는 보이지 않았다. 결론 : 임신중반기에 시행하는 태아기형의 초음파적 검진시 필수적으로 제대의 검진이 포함되어야 하며 만약 단일제대동맥이 확인되는 경우 동반기형 및 염색체이상의 유무를 확인하기 위한 태아심초음파를 포함한 정밀초음파검사 및 염색체검사가 시행되어야 하고, 동반기형 및 염색체이상을 동반한지 않는 단독 단일제대동맥태아에서는 임신중 자궁내 성장부진에 대한 세심한 관찰이 필요하겠다. Objective : To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes. Materials and Methods : 30 fetuses with a single umbilical artery were detected by prenatal ultrasound exanmination between March 1998 and June 2001 at Eul-Ii University Hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications, and neonatal outcome. Results : Of the 30 fetuses, 11 (36.7%) were terminated because of severe anomalies and 2 (6.7%) experienced neonatal death. 17 fetuses (56.7%) bad an associated structural anomaly. The structural anomalies found in association with single umbilical artery were cardiovascularac system (9 cases, 30.0%), urogenital system (6 cases, 20.0%), central nervous system (5 case, 16.7%) and ectopia cordis (1 case, 5.9%) and 7 cases (20%) among these had multiple malformations. Karyotype analysis was availabe in 25 cases and 5 (20%) of these were chromosomally abnormal. All of the karyotypically abnormal fetuses had a structural defect diagnosed on prenatal ultrasound examination in addition to the single umbilical artery. Of 13 fetuses without any associated structural or chromosomal anomalies, 3 (23.1%) demonstrated growth restriction. Of the 26 cases identified the absent side of a single umbilical artery, the right umbilical artery was absent in 13 (50%) and the left in 13 (50%) fetuses. The frequency with associated structural and chromosomal anomalies was equal on right (53.8%; 15.4%) and left (69.2%; 15.4%) sides. Conclusion : Scanning the umbilical cord should be one of the essential parts of 2 nd trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examnination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities. In cases where single umbilical artery is an isolated finding on prenatal ultrasound, careful attention to fetal growth is necessary.

시험관 아기 시술에서 여성의 연령이 수정란의 질과 다태 임신 발생에 미치는 영향

이명섭,박장옥,정지학,박준숙,강희규,김동훈,이호준,Lee, Myeong-Seop,Park, Jang-Ok,Jung, Ji-Hak,Park, Jun-Suk,Kang, Hee-Gyoo,Kim, Dong-Hoon,Lee, Ho-Joon 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.3

Objective: This study was performed to evaluate the influence of maternal age on embryo quality and the frequency of multiple pregnancy in IVF-ET program. Method: 86 conventional IVF-ET cycles were divided into three groups according to the age by 5 year (group A: 26-30, group B: 31-35, group C: 36-40 yrs). The in vitro fertilization and development outcome (fertilization, cleavage and high quality embryo rate) and the pregnancy outcome (pregnancy, implantation, G-sac/high quality embryo and multiple pregnancy rate) were examined. And then, these results were compared among the groups. Results: The rates of fertilization (62.7, 68.5 and 65.4%, respectively) and cleavage (95.6, 97.6 and 98.0%, respectively) were not different among the groups. And the high quality embryo (HQE) rate also was not different among the groups (61.8, 62.9 and 62.8%, respectively). The pregnancy rate of group C (23.3%) was significantly lower than that of group A (41.2%) and B (48.7%). And the implantation rate was significantly decreased with advance in maternal age (group A; 17.3%, B; 12.6% and C; 6.0%). The G-sac/high quality embryo rate was significantly higher in group A (70.8%) when compared to group B (32.2%) and C (40.0%). On the other hand, the multiple pregnancy rate was significantly lower in group C (14.3%) when compared to group A (71.4%) and B (36.8%). Conclusion: The pregnancy rate was significantly decreased over 35 years. The G-sac/HQE and multiple pregnancy rate were significantly high below 31 years. Thus, these results suggest that the number of high quality embryo transferred should be limited by the age and another criteria for embryo quality evaluation were required for single embryo transfer.

복강경하 질식 전자궁적출술, 질식 전자궁적출술 및 복식 전자궁적출술의 임상적 비교

민병강 ( Byoung Kang Min ),박준숙 ( Joon Suk Park ),류지훈 ( Ji Hoon Ryu ),김억배 ( Eok Bae Kim ),심삼용 ( Sam Young Shim ),송영래 ( Young Rae Song ),김기환 ( Ki Hwan Kim ),강경화 ( Kyung Hwa Kang ),이병관 ( Byung Kwan Lee ),노정 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8

목적: 복식 전자궁적출술, 복강경하 질식 전자궁적출술 및 질식 전자궁적출술의 수술 적응증 및 장단점과 안전성을 비교하기 위해 본 연구를 시행하였다. 연구 방법: 2002년 6월부터 2005년 6월까지 시행된 TAH, LAVH, TVH를 시행한 환자를 대상으로 후향적으로 임상 자료를 비교 분석하였다. 결과: 세 군의 연령, 신장, 체중 및 출산력은 유의한 차이가 없었고, 수술 기왕력은 TVH군에서 25%로 TVH군의 56%, LAVH군의 40%보다 유의하게 적었으며, 수술 적응증은 세 군 모두 자궁 근종이 가장 많았다. 세 군의 수술 전후 혈색소 및 적혈구 용적의 변화량을 통한 출혈량의 비교에서는 유의한 차이가 없었으며, 평균 자궁의 무게는 TAH 군은 443.6g으로 LAVH의 301.9g과 TVH의 225.3g에 비해 유의있게 무거웠다. 수술 시간은 LAVH군에서 76.7분으로 TAH군의 59.6분과 TVH군의 70.2분에 비해 유의하게 길었으나, 수술 후 통증은 TAH군이 3.75점으로 LAVH군의 2.93점, TVH군의 2.71점보다 유의하게 높았으며, 입원 기간도 TAH군이 7.30일로 LAVH군의 5.19일, TVH군의 5.21일보다 유의하게 길었다. 수술 후 합병증은 TAH군에서 15%, LAVH군에서 11%, TVH군에서 13%로 세 군 사이의 유의한 차이가 없었으며 모두 보존적 치료 및 경과 관찰로 회복되었다. 결론: LAVH와 TVH는 수술 후 통증, 미용상의 잇점, 입원 기간의 단축 등의 장점이 있으나 TVH는 수술 시야의 협소 및 유착시 제한, LAVH는 의료비 상승의 단점이 있으므로 각각의 수술 적응증 및 금기증을 확립하여 환자의 만족도와 안전성이 높은 술식의 선택이 필요하겠다. Objective: To compare the clinical results for women undergoing total abdominal hysterectomy (TAH), laparoscopic assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). Methods: We reviewed the medical records of patients who underwent TAH (n=97), LAVH (n=112) and TVH (n=95) from June 2002 to June 2005. We compared and evaluated patient`s characteristics, previous abdominal operation histories, indication of hysterectomy, uterine weight, operative time, perioperative hemoglobin and hematocrit change, the degree of postoperative pain, hospital stay and complications. Results: The patient`s characteristic (age, weight, height, parity, perioperative hemoglobin and hematocrit change, complication rate) had no statistical difference in all three groups. In the TVH group, the rate of previous abdominal operations (25%) was significantly lower than TAH (56%), and LAVH (40%) (p=0.023). The mean uterine weight was the heaviest in TAH group (443.6±407.3 g), compared to LAVH group (301.9±133.9 g) and TVH group (225.3±91.8 g) (p<0.001). Operative time was the longest for LAVH group (p=0.001), and there was no significant difference between TAH group and TVH group (p=0.087). The TAH group had the highest postoperative pain scale and the length of hospital stay. The LAVH group and TVH group had almost the same postoperative pain scale and the length of hospital Conclusion: Both LAVH and TVH had the following advantages compared with total abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages. But limited operation field in TVH and expensive operative cost in LAVH were disadvantages. Specific guidelines for determining the route of hysterectomy result in decreased morbidity and lower costs, and thus the gynecologist can ensure that the patient receives the best possible surgical care.

임신 28 주에서 36 주 사이의 조기분만에서 쌍태임신과 단태임신의 주산기 예후 비교

오관영(Kwan Young Oh),박미혜(Mi Hye Park),양윤석(Yun Seok Yang),황인택(In Taek Hwang),박준숙(Joon Suk Park) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.10

목적 : 28주에서 36주 사이에 조기 분만한 산모를 대상으로 쌍태임신과 단태임신의 주산기 예후를 비교 하고자 하였다. 연구 방법 : 1996년 1월에서 2000년 12월 사이에 대전 을지대학병원에서 출생한 28주 이상 36주 사이의 조기 분만을 한 산모를 대상으로 쌍태임신 80명, 단태임신 402명의 진료기록을 분석하였다. 결과 : 1. 임신과 동반한 합병증은 임신중독증의 경우 단태임신에서 11.7%, 쌍태임신에서 12.5%, 태반 조기박리의 경우 0.75%: 1.25%로 유의한 차이가 없었고, 빈혈은 14.7%: 44.3%로 쌍태임신에서 유의한 차이로 증가되어 있음을 알 수 있었다 (p<0.05). 2. 단태아의 출생체중은 2368±504 g, 제1 태아 2198±402 g, 제2 태아 2184±402 g으로 단태아가 제1, 제2 태아보다 유의하게 증가되어 있었다. 그러나 제1, 제2 태아간의 출생체중은 유의한 차이가 없었다 (p<0.05). 3. 단태임신과 쌍태임신의 유리질막증 질환, 뇌실내 출혈, 미숙아 망막증, 선천적 기형 등의 빈도는 두 그룹 사이에 유의한 차이는 없었다. 그러나 황달의 빈도는 단태아에서 제1, 제2 태아보다 많았고, 폐혈증의 경우 제2 태아보다 단태아가 많았다. 뇌실내 출혈은 제1 태아에서 단태아보다 많았으나, 쌍태아간 차이는 없었다. 그러나 전체 유병일과 주산기 사망률은 3그룹 사이에 유의한 차이가 없었다. 결론 : 조기분만시 쌍태임신과 단태임신에서 출생한 신생아의 주산기 예후는 유의한 차이를 보이지 않았다. Objective : To compare the perinatal outcomes in twin and singletone pregnancies delivered prematurely between 28 and 36 weeks gestational age. Methods : We studied 80 pairs of twin delivered between 28 weeks and 36 weeks gestational age at Eulji university hospital between January 1996 and October 2000. The perinatal morbidity and mortality in premature twin pregnancies were compared to those of premature singleton pregnancies (N=402). Results : The premature twin pregnancies had no significant differences of gestational age at delivery than those of singleton pregnancies, but significantly lower mean birth weight. In mean day of hospital stay, 1 and 5 min Apgar scores, there were no significant differences. There were no significant differences in the incidence of neonatal morbidity such as hyaline membrane disease, and retinopathy of prematurity, between the two groups. And also the perinatal mortality was not significantly different between the two groups. Conclusion : There were no significant differences in perinatal mortality and morbidity between the two groups.

임신중 철분제제 투여가 임산부 혈색소치와 신생아 체중에 미치는 영향

황인택 ( In Taek Hwang ),박미혜 ( Mi Hye Park ),양윤석 ( Yun Seok Yang ),오관영 ( Kwoan Young Oh ),정지학 ( Ji Hak Jeong ),박준숙 ( Joon Suk Park ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

N/A Objective :This study was performed to evaluate the effects of oral administration of iron supplements during pregnancy on maternal hemoglobin concentrations and birth weights. Method: Data from clinical records of 141 pregnant women and their babies were analysed. Studied mothers were classified to 3 groups such as non iron supplement group (group I ), 2-3 months supplement group (group II), and over 4 months supplement group (group III) by the duration (months) of oral supplement prescribed. Results : There was positive correlation between hemoglobin levels and iron supplement duration. Proportions of anemia showed decreasing basis with the increasing iron supplement duration. The maternal hemoglobin levels showed decreasing basis with the increasing birth weight. There was positive correlation between iron supplement duration and maternal hemoglobin levels, but there was no significant correlation between iron supplement duration and birth weight. For the group I (non-supplement group), maternal hemoglobin levels were decreased with the increasing birth weight but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration. Conclusion :There was a significant inverse correlation between matemal hemoglobin levels and birth weight in non-iron supplement group but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration.

폐경후 여성에서 척추 골밀도 변화에 대한 다변량 회귀분석

양윤석 ( Yun Seok Yang ),오관영 ( Kwoan Young Oh ),박미혜 ( Mi Hye Park ),황인택 ( In Taek Hwang ),정지학 ( Ji Hak Jeong ),박준숙 ( Joon Suk Park ) 대한폐경학회 2001 대한폐경학회지 Vol.7 No.1

N/A Objective : Using multiple linear regression models, We have determined the relationship between the dependent variables, spinal bone mineral density(BMD) and easily obtained biometrical variables in 250 postmenopausal women Method : The main outcome measures were patient`s age, menstrual and menopausal factors (age at menarche, age at menopause, duration after menopause), anthrophometric factors(height, weight, BMI), obstetric history(number of delivery, abortion and feeding). Dual energy X-ray absorptiometry(DXEA) was performed at L2-4 region of Lumbar spine in 250 postmenopausal women during the 2 year from June 1998 to June 2000. these data were analyzed using SPSSWIN 9.0 statistic program. Results : After stepwise multiple regression analysis, spinal BMD in postmenopausal women is 0.563-0.0077(duration of menopause, year)+0.0054(body weight, ㎏)(p<0.001, R2=0.30) Conclusion : This study suggests that multiple regression models examining determinants of bone density at the lumbar regions showed that prolonged duration of menopause and decreased body weight in postmenopausal women were statically significant predictors of bone demineralization.

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

16세 여아에서 연속적으로 발생한 양측성 자궁부속기 염전 복강경을 이용한 보존적 치료로 성공한

김정현 ( Jeong Hyun Kim ),강경화 ( Kyoung Hwa Kang ),양윤석 ( Yoon Seok Yang ),황인택 ( In Taek Hwang ),박준숙 ( Joon Suk Park ),김승현 ( Seung Hyun Kim ),김진섭 ( Jin Sub Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

Adnexal torsion is a disease occurring mostly in young fertile women that causes severe pain with necrosis of the adnexa requiring an emergency surgery. Because the symptoms and physical findings are similar to emergency diseases of adjacent organs such as appendicitis, diagnosis of adnexal torsion could be confused. Delayed diagnosis leads to delayed operation and for that reason adnexectomy is done more often than conservative management. Since prompt diagnosis is the sole way for preservation of the ovary and the salpinx, early diagnosis of adnexal torsion is essential. We experienced a case of a 16 year old female with torsion of the right adnexa who had the left adnexa previously removed due to torsion of the left adnexa. The case is presented with review of the literature.

제대혈 천자술 112예의 임상적 분석

조윤성 ( Yoon Seong Cho ),이병관 ( Byung Kwan Lee ),이원진 ( Won Jin Lee ),박미혜 ( Mi Hye Park ),오관영 ( Young Kwoan Oh ),양윤석 ( Yun Seok Yang ),황인택 ( In Taek Hwang ),박준숙 ( Joon Suk Park ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

목적 : 산전 진단에 있어서 진단적 제대혈 천자술의 안정성 및 효용성을 알아보고자 본 연구를 시행하였다. 연구 방법 : 1998년 3월부터 2002년 2월까지 초음파 유도하 경피적 제대혈 채취를 112명의 산모에서 시행하였고, 제대혈 천지술을 시행하였던 112명의 기록을 조사하였다. 결과 : 대상 산모의 임신 주수는 17주에서 36주 사이였다. 산모의 평균 연령은 29.6세이고 제대혈 천자 당시의 평균 임신 주수는 27.8주였다. 83예에서 (74.1%) 비정상적인 초음파 소견으로 적응중이 되어 빠른 핵형 분석을 시행하엿다. 112예 중 105예에서 (93.8%) 성공적으로 태아 혈액을 채취하였고, 그 중 99예에서는 (88.4%) 첫 번째 시도에서 성공하였다. 103예 중 9예에서 (8.7%) 염색체 이상이 발견되었고 초음파상 구조적 이상을 보였던 70예 중 8예에서 (11.4%) 비정상적인 염색체 소견을 보였다. 제대혈 천자술과 연관된 합병증으로는 태아서맥이 3예에서 (2.7%) 발생하였다. 결론 : 본 연구에서 제대혈 천자술은 태아의 산전 진단에 유용하고, 비교적 안전하며, 효율적인 방법으로 사료된다. Objective : This study was performed to assess the safety and efficacy of the diagnostic cordocentesis in prenatal diagnosis. Methods : Between March 1998 and February 2002, percuteneous umblical cord blood samplings under the ultrasonographic guidance were performed in 112 patients. We reviewed the medical records of 112 patients who were performed cordocentesis. Results : Gestational age ranged between 17 and 36 weeks. The mean maternal age was 29.6 years and the mean gestational age at the time of cordocentesis was 27.8 weeks. Among the patients, 83 cases (74.1%) were done with the indication of abnormal sonographic finding and followed by rapid karyotyping. Pure fetal blood was successfully obtained in 105 cases of 112 cordocentesis (93.8%). 99 cases (88.4%) were done successfully at the first attempt. Chromosomal abnormalities were found in 9 of 103 fetuses (8.7%). Abnormal chromosomal patterns were found in 8 of 70 fetuses (11.4%) with structural anomalies detected by ultrasonography. The procedure-related complication, fetal bradycardia occured in 3 cases (2.7%). Conclusion : We conclude that cordocentesis is a useful, relatively safe, and effective procedure for prenatal diagnosis.