산부인과 영역에 있어서 초음파장치의 임상적 이용 ( I )

박찬무(CM Park),박영세(YS Park),김용철(YC Kim),박찬용(CY Park),엄승호(SH Ohm),이우홍(WH Lee) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

저자는 자궁내 태낭의 성장속도와 태아의 성숙도 및 태아예상체중을 위한 방법으로 정상임 신부 422명중 63명에게는 태낭을 위해 1회의 초음파 단층촬영을, 359명에게는 아두대횡경치 를 위해 1회의 초음파단층촬영을 실시했고 아두대횡경치에 의한 태아 예상체중을 위해 신생 아 97명의 분만후 24시간내에 신생아 체중을 계측하여 임신월령에 따른 태아 아두 및 예상 체중의 희귀직선을 산출하여 다음과 같은 결론을 얻었다. 1. 임신재태기간 제 5주부터 12주사이의 정상임신부에서 태낭은 제 5주에 5명중 3명에서 (66%) 제 6주는 9명중 7명에서 (77%) 최초로 태낭이 보였고 7주 이후에서는 모든 예에서 태 낭이 관찰되었다. 2. 임신재태기간 제 5주부터 12주까지 임신주수에 다른 태낭의 성장은 y=0.62 X (wks) - 1.75로 0.57cm/week의 비율로 성장한다. 3. 임신재태기간 제 11주부터 40주까지 임신주수에 따른 아두대횡경치는 y=0.27 X (wks) - 0.88로 성장하고 임신재태기간 제11주부터 20주까지는 0.34cm/week로 제 21주부터 40주까지 는 0.23cm/week의 증가율을 나타낸다. 4. 임신제대기간 제 35주부터 40주까지 각 임신주수에 다른 아두대횡경치에 의한 아두대횡 경치에 의한 태아 예상체중은 y=1.14 X (mean BPD) - 7.2(kg)로 0.16kg/week의 증가율로 나타난다. The ultrasonic measurements of fetal biparietal diameter (BPD) were obtained by real time scanning (ADR 2130) from 380 times in normal 359 pregnant women between 11th to 40th gestational weeks. Before 11th gestational weeks of pregnancy, gestational sac was measured by same method from 81 times (63cases). The results of these data were as follows; 1. the regression line according to the increment of gestational sac between 5th and 12th gestational weeks; y=0.62 X (wks) - 1.75. 2. The regression line from 11th to term of biparietal diameter ; y=0.27 X (wks) - 0.88 and the growth rate of the biparietal diameter during same period (0.34cm/week) was faster than one of 21th-40th gestational weeks (0.23cm/week). 3. The expected fetal body weight was calculated from the regression line (y=1.14 X (mean BPD) - 7.2(kg)) was obtained from sonar measurement of biparietal diameter (from 35th to 40 th gestational weeks).

흡인분만과 감자분만

박찬무(CM Park) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.5

국립의료원에서 흡입분만을 시작한 것은 1962년 11월부터 이었으며, Malmstrom과의 용수흡입기를 사용하고 있으며 cap은 3,4,5의 3종으로 명명 3cm,4cm,5cm의 직경을 표변하고 있다. 먼저 임상소견을 진찰기록에 의하여 종합하여 표로 제변하고 그 성적을 검계하여 보고자 한다. 결 론 (1)흉인분만은 분명히 간편하고 안전한 방법이며 대부분의 기형분만의 적응에 있어서 감자에 대치될 수있다. (2)흉인분만은 제왕절개분만의 빈도를 감소시킬 수있다고 생각되지 않는다. (3)흉인분만은 단순히 분만제2기를 단측시키기 위하여 남용하여서는 안된다. (4)금소예를 제외하고 흉인에서 실패하면 감자를 시도할 필요없이 바로 제왕절게로 이행하는 것이 안전하다. 그러나 이상과 같이 결론이 감자분만을 부정하는 것은 아니며 각자의 경험과 수기의 숙련도에 따라 임의로 사용될 수 있으며 어느 한쪽을 부정할 수는 없다. 그러므로 아직도 감자분만이 널리 사용되고 있는 현실에 비추어 수련의사의 교육을 위하여서는 최소한 감자분만 (수로 선택적감자분만, elective forceps delivery)을 겸용하는데 성한다. 그러나 흡입문만은 조작이 용이하여 수련의 필요성이 없으므로 수련목적으로 감자만을 사용케 한다는데 대하여서는 임상의의 진료목적과 수련목적을 혼동하는 감이 불무하다.

인공임신중절의 법적문제

박찬무(CM Park) 대한산부인과학회 1962 Obstetrics & Gynecology Science Vol.5 No.5

가족계획이 국가재건운동의 중요한 일부를 부담하고 있는 차제에 합법적인 인공임신중절에 관하여 우리나라 형법은 하나도 구체적인 조문이 없음은 확실히 법의 미비점을 로정하고 있다.막연한 법조문은 법관의 자유재량에 의하여 판결되는 경우 의사의 입장으로서는 양심껏 판단하여 결행한 시술이 혹시나 법적제재를 받게 될까 두려워 전전긍긍하는 예도 있을 수 있고 이와 반대로 가족계획 본래의 의의를 망각하고 이를 용적하여 법망의 저변을 해쳐가는 경우도 허다함은 주지의 사실이다. 따라서 이러한 이차적인 부작용을 없애기 위하여도 하루 속히 뚜렷한 윤곽을 그려주는 법령의 개정을 창도하는 바이다. 이러한 소망은 결코 무제한 인공중절을 자행하고저 하는 심정에서 주장하는 것은 결코 아님을 재삼 강조한다.

상위태반조기박리환자의 혈액응고상과 저섬유소원혈증

박찬무(CM Park),신면우(MW Shin),윤영선(YS Yoon) 대한산부인과학회 1958 Obstetrics & Gynecology Science Vol.1 No.1

일예로 상위태반조기박리환자 혈액응고상을 관찰하여 선유소원의 감소와 동시에 Prothrombin 및 불안전인자의 저하도 볼 수 있었다. 외국에서 발표된 본 증예의 보고에서는 Biggs 씨가 본증에 Prothrombin과 불안정인자의 저하도 겸하게 되는 일이 있다고 언급하였을 뿐 대개가 긴급대책으로서 선유소원량만의 측정에 그쳤던 것이었으나 저자들은 다행히 출혈경향을 보이지 않는 예였으므로 시간적여유를 가지고 여러가지 응고인자능을 검사할 수 있어 전기한바와 같은 결과를 얻었다. 겸하여 저선유소원혈증과 발생원인, 진단 및 치료 등에 관하여 총괄하였다. 일례의 체험에 불과하므로 추후 예수를 거듭하여 본증의 혈액응고상을 추구할 태세를 갖추고 있다. De Lee made the observation in 1901 that the blood of patients with abruptio placentae failed to clot, even after several days, and he described the conditions as "temporary hemophilia". However the nature of this homphilic phenomenon was not investigated system at ically until recently. The first demonstration of the nature of the defect was made in 1936, by Dieckmann who found significantly reduced levels of blood fibrinogen in patients who hemorrhaged following abruptio placentae. There is no longer any doubt that the hemorrhagic stage which occasionally follows severe cases of abruptio placentae, as well as fetal death in utero and amniotic fluid embolism is due to the depletion of fibrinogen. There are two current theories, however, as to the cause of this depletion either the lysis of fibrinogen by a plsma fibrinolysin or the consumption of fibrinogen that is due to the escape of placental or decidual thromboplastin into the maternal blood stream. Of two theories, the latter is more readily accepted by many workers, because the fibrinolysis is by no means a constant feature and is absent in some cases associated with hypofibrinogenemia. In the case reported in this paper we observed the blood coagulation feature of a patient with parrial abruptio placentae, in three different stages - antepartum, immediately after delivery and 22 hours after delivery - who did not show any overt hemrrhagic condition. The results are as follows : In antepartum, at 7 hours prior to delivery due to initial uterine bleeding, the fibrinogen level was slightly reduced, while the prothrombin time was nearly within normal limits, and prothrombin as well as labile factor(Factor Ⅴ) were likewise reduced moderately. Immediately after aelivery there was marked fibrinogen depletion and moderate reduction of prothrombin and labile factor, while prothrombin time remained at the same level in antepartum, but none of these reductions was to a degree sufficient to cause hemorrhage. Twenty two hours after delivery all factors, including the fibrinogen, were restored to normal level. In all three stages, however, stable factor (Factor Ⅶ) showed an abnormally high level while recalcification time (Calcium clotting time) and heparin tolerance test (Heparin Retarded clotting time) were almost within normal limits, though immediately after delivery they were slightly prolonged. B cause of the urgency in cases of abruptio placentae many classical experimental methods are often of more academic interest than of value to the clinician, and several rapid and simple quantitative tests for fibrinogen have been introduced by workers in this field. As to the treatment of hypofibrinogenemia, for the present we must rely largely upon the use of blood and plasma. Although rational treatment should aim at restoring the fibrinogen level with fibrinogen injection, depending upon the relative need for red blood cells, we must also realize that with severe fibrinogen depletion many units may be required to resotre the clotting power of the blood.

제왕절개 자궁적출술의임상적 고찰

박찬무(CM Park),박형무(HM Park),엄승호(SH Ohm),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.5

1. 제왕절개자궁적출술을 받은 환자 32예중 66%의 예에서 산과적 출혈에 의한 응급을 요한 수술이었다. 이의 적응증으로는 자궁파열이 6예로 18.75%를 차지하였고, 이완성 자궁출혈이 5예 (15.63%), 유착태반이 4예(12.5%) 전치태반에 의한 지혈곤란, 자궁근종, 자궁경부암 및 불임 목적으로 각각 3예씩 (9.38%)을 차지하였고 기타의 경우가 15.6%를 차지하였다. 2. 심한 출혈로 인한 쇼크 상태의 환자 즉 쿠베레어 자궁이나 지혈곤란의 경우에선 부분적 자궁적출술을 시행하였고 다발성 자궁근종의 경우는 출혈은 심하지 않았으나 수술상의 난점 으로 역시 부분적 자궁적출술을 실시하였다. 3. 수술후 21예(65.6%)에서 아무런 합병증이 없었으며, 합병증이 나타난 예에서는 창상감염 및 파열이 4예(12.5%)로 가장 많았고 요로감염 및 방광손상에 의한 방광무력증이 각각 2예 로 6.25%를 차지하였고, 그외 골반농양, 마비성 장폐쇄, 복막후강출혈등이 1예씩 있었다. 4. 산모사망은 2예(6.25%)로 비교적 높은 비율을 차지하였는데, 그중 1예는 수술중 지혈곤란 으로 사망하였고, 다른 1예는 패혈성 쇼크환자로서 수술후 골반농양, 장누공 및 패혈증으로 사망하였다. This study was undertaken to determine the present status of cesarean hysterectomy. Cesarean hysterectomy was originally devides to combat postcesarean infection and hemorrhage, and it indication have gradually been widended to include many conditions in which removal of the uterus is necessary or desirable. In this study the outcome of 32 cases of cesarean hysterectomy performed at National Medical Center during 18 years from Jan. 1962 to Dec. 1979 was discussed and evaluated. There were 21042 deliveries during this period. Cesarean hysterectomy was performed in 32 of 1360 cesarean section, an incidence of 2.35%. The incidence of cesarean section was 6.46%. The age of patients varied needed immediate emergency operations. In about 2/3 of total patients (65.6%) there were no postoperative complications There were 2 cases of maternal mortality in this series . They underwent cesarean hysterectomy for placenta previa and postpartum intrauterine infection, however, ond died of sepsis and the other of uncontrollable bleeding. To prevent these catastrophies periodic and meticulous antenatal care must be provided.

분만 예에 있어서 모성건강기록의 임상통계학적 분석 ( III )

박찬무(CM Park),이우흥(WH Lee),송시종(SJ Song),김종현(JH Kim) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.9

1980년 8월1일부터 1981년 5월31일까지 만 10개월간 분석조사한 결과 다음과 같은 결론을 얻었다. 1. 총 분만 878예 중 초산모가 495예(56.38%) 경산모가 383예(43.62%)이었다. 2. 산전 산모의 상태는 합병증이 없는 경우가 544예(84.77%)로 대부분이었고, 합병증이 있는 경우는 임신성 고혈압 48예(7.45%) 생식기 및 골반의 이상 8예 (1.24%) 산전 질출혈 7예 (1.09%) 감염 7예(1.09%) 및 혈액 소견의 이상이 5예(0.78%)의 순이었다. 3. 분만 방법은 정상 질식분만이 559예(63.67%)로 가장 많았고 제왕절개술 153예(17.43%) 및 기계분만 143예(16.29%)의 순이엇다. 4. 분만 중 합병증은 분만지연이 124예(14.71%) 질출혈이 25예(2.97%) 태반계류 17예(2.02%) hypotonic uterine contraction 이 8예(0.95%) 및 전치태반 3예(0.36%)의 순이었다. 5. 분만 시술자는 산부인과 전공의 (레지던트)이상이 수술한 경우가 739예(88.50%)로 가장 많았고 일반전공의가 분만 시술한 경우는 84예(10.06%)이며 그외는 실습 조산원, 조산원, 간 호원 등이 시술하엿다. 6. 제왕절개술의 적응증은 제왕술이 기왕력이 51예(33.33%)로 가장 많았고, 이상 태위가 26 예(16.99%), 분만지연이 26예(16.99%) 이두골반불균형이 5예(3.27%) 유도분만 실패 5예(3.27%) 및 임신 중독증 4예(2.61%)의 순이었다 7. 평균 신생아 체중은 3179.83±471.40gm이었으며 초산은 3109.32±445.48gm이엇고 경산은 3267.99+-490.83gm이었다. 8. 신생아 평균 1분 Apgar score는 7.82±0.94이었으면 5분 Apgar score는 7.85±1.04이었다. 1. The mean age of delivered women was 27.69±3.66 year, mean educational duration 10.95±1.75 years, mean age of first marriage : 24.83±2.75 year, the times of mean antenatal visit : 3.99±2.96 and mean duration of pregnancy : 39.77±2.11 weeks. 2. The incidence of primary antenatal complications was 15.33% in 644 cases, of which hypertensive disorder was the most one (7.45%). 3. The methods of delivery wer as follows ; sponataneous vaginal delivery : 559 cases (63.67%), C-section : 153 cases (17.43%) and vacuum extraction : 143 cases (16.29%) 4. Of 202 cases of intrapartum complications, prolonged/obstructed labor was major one (14.71%). Others were hemorrhage (2.97%) retained products (2.02%), hypotonic uterine contraction (0.95%) and placenta previa (0.36%), etc 5. Majority of attendant at delivery was resident or staff (88.50%). 6. Indication of cesarean section revealed as previous history of cesarean section (33.33%) malpresentation (16.99%) prolonged/obstructed labor (16.99%), cephalopelvic disproportion (3.27%) failed induction (3.27%) toxemia(2.61%) and so 7. the mean body weight of newborn was 3179±471.40gm. 8. The mean Apgar score at one minute was 7.82±0.94 and at 5 minute after birth 7.85+-1.04

우리나라 여성 불임술에 관한 고찰

박찬무(CM Park),황영환(YW Whang) 대한산부인과학회 1980 Obstetrics & Gynecology Science Vol.23 No.7

The use of female sterilization in Korea increased tremendously during the past three years, 1977 through 1979, as the government began promoting female sterilization as a mainstay of the national family planning program by providing augmented government subsidy to physicians performing female sterilizations. Of a total of 570,114 female sterilizations performed during the period under the government support, the majority of cases were done via laparoscopy technique which represents markedly high rate in comparison with other methods of sterilization. Performing a large number of sterilizations and for the implementation of the efficient voluntary laparoscopy sterilizations, it is believed that the nationwide evaluation on complications and failures as well as any problems following laparoscopic sterilization is imperative. For this evaluation, the pre-designed questionnaires were distributed to a total of 632 government-designated physicians doing laparoscopy sterilization, and 310 physicians responded as of December 1979. The completed questionnaires were analysed and the following results were obtained. 1. Of a total of 310 respondents, the greatest number of physicians having laparoscopy experience for 2-3 years shared 36.9% of the total and 47 physicians, 14.9%, have laparoscopy experience for 4 years and over. 2. Quantiatively, 24.5%, almost one quarter, of total physicians performed 3,000 to 5,000 procedures. It is noteworthy that three physicians performed even more than 10,000 procedures. 3. I`m looking at the number of physicians by their main technique used, the greatest number of physicians perferred coagulation plus division technique comprising 38.1%, while the Bipolar coagulation technique occupied the lowest rate of 17.1%. 4. Among a total number of 390,249 procedures performed by 310 respondents, the greatest number of cases was performed via coagulation-division technique, comprising 54.2% of the total procedures. 5. As to the failure rate of the laparoscopic sterilization, a total of 655 pregnacies were reported on the questinnaires, which represented 0.17%. The highest failure rate of 0.43% appeared in the Bipolar coagulation technique while the lowest failure rate of 0.02% were in the Ring application technique. The reason Bipolar technique had the highest failure rate could be attributed to the fact that the most training institutions in KOrea have not been equipped with Bipolar equipment for the suficient practical training on proper technique of Bipolar coagulation. 6. Operative complications during laparoscopic sterilization requiring explo-laparotomy were reported in 89 laparoscopic procedures, comprising 0.023% of the total; 29 bleeding cases and 60 bowel injuries. Of the bleeding cases, the highest rate of 0.012% marked in Ring application technique and the highest in bowel injuries rate of 0.022% Coagulation and division technique. 7. Ectopic pregnancy following laparoscopic sterilization was the most frequent disastrous complication reported by respondents, occurred in 163 cases comprising 0.024% of the total precedures. Bipolar coagulation represented the highest ectopic pregnancy rate of 0.005%. The high rate of ectopic pregnancy in Bipolar coagulation technuique may be caused by improper coagulation or some other technical failures owing to insufficient practical training. 8. Currently, many physicians perform laparoscopic steriilixation combined with first trimester abortion without noticeable problems. The greatest number of physicians performed 31%-40% of combined procedures of laparoscopic sterilization and MR procedure t the same time. It is remarkable that 6 physicians performed this combiend procedure in more than 91% of the total procedures and 10 physicians perfored 81-90%.

여성 요루에 관한 임상적 고찰

박찬무(CM Park),최근혜(GH Choi),조인제(IJ Cho) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.2

One hundred thirty patients with urinary fistulas had been admitted in the Gynecological Ward of the National Medical Center, Seoul, during 13 years, from the beginning of 1959 through the end of 1971, of which 109 patients were actually submitted to the surgical treatment. A review of these cases indicated that complete investigation of the urinary tract should precede repair, since these abnormal communications appeared in many varieties and might be multiple. Anatomic as well as etiologic considerations were important in diagnosis. The causes of these fistulas were analysed and methods of management were reivewed. Particular attention was paid to those patients in whom surgical repair of the fistula was undertaken and an attempt was made to evaluate the factors responsible for success of repair. The results of clinical observations were summarized as follows: 1. Seventy five out of 130 patients were obstetric fistula and more than half of them belonged to the second decade(50.7%), while in 55 of the non-obstetric fistula cases the greatest incidence was observed to be in the fourth decade(47.3%). 2. Presumed etiologic agents of the fistula showed 75 out of 130 patients were caused by various types of obstetric operation and large numbers were found in prolonged labor with or without forceps delivery and craniotomy. Etiologic agents of non-obstetric fistula could be divided into 26 of hysterectomy either simple or radical, 19 of chemical cauterization for total uterine prolapse with strong acid by laymen, 3 of genito-urinary tuberculosis, 2 of irradiation after hysterectomy due to ovarian cancer and 5 others. 3. The majority of patients, both obstetric and non-obstetric, belinged to vesicovaginal fistula, comprising 72.3%. As for the ureterovaginal variety, 17 patients consisted of 15 non-obstetric and only 2 obstetric. 4. The fistulas of less than 2cm in diameter could be found most frequently both obstetric and non-obstetric. It was our general concept that the size did not influence as much as the location of fistulas. 5. In 89 of 109 patients, various types of baginal approach were undertaken with 73(82%) patients of success. Twenty patiens, all of ureterovaginal variety as well as technically difficult patients were submitted to abdominal precedures with 18 patients(90%) of success. The combined, abdominal and vaginal approach was performed for 2 cases of complicated vesicovaginal variety with 2 patients of success. Six of 109 patients had to be resorted to various types of diversion with 5 patients of success. Nine of 130 fistulas healed spontaneously. All spontaneously healed fistulas occured as the results of surgical trauma, 3 of radical hysterectomy, 4 of abdominal total hysterectomy and 2 of subtotal hysterectomy. 6. In 109 patients operarive procedures were carried out on 137 occasions. Final cure rate of surgical repair was decreased by the number of surgical attempts made. But it seemed to be worthwhile to try repeated attempts, even more that 5 times in some selected cases, with patience and deliberated evaluation. 7. Obstetric fistulas were usually poor outcome(80.3%) than non-obstetric(89.5%), because most of them were so large and fibrosis were so extensive that it was impossible to make sufficient mobilization of the surrounding tissue to make suture without tension. In the present series, overall success was 91 of 109 patients, or 83.5% of the whole, during 13 years. 8. Genito-urinary infection was the most common complication and E. coli was the most common causative organism of urinary infection. 9. Unobstructed postoperative urinary catheter drainage was of primary importance.

부인과 질환의 초음파 진단의 임상적 가치

박찬무(CM Park),장경식(KS Chang),이규완(KW Lee),유명숙(MS Yoo),이강보(KB Lee),강대웅(DW Kang) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.12

1980년 10월1일부터 1981년 9월30일까지 국립의료원 산부인과에 입원하여 수술한 총 84예의 환자를 대상으로 수술전 시행한 초음파 단층상과 내진소견 등 임상적 소견 및 개복수술 또 는 소파수술이나 기타 방법으로 얻어진 최종소견과 비교하여 다음과 같은 결론을 얻었다. 1. 84예 환자중 양성 난소종양 28예로 33.8%, 악성종양은 4예로 4.8%, 염증성 병변이 8예로 9.5%, 자궁체부 병변 20예로 23.8%, 병적임신상태가 18예로 21.4% 기타 자궁내 장치확인 등 이 6예이었다. 2. 28예의 양성 난소종양은 모두 초음파촬영으로 확진할 수 있었다. 점액성 난소종양이 11예 로 42.3%, 장액성낭종은 6예로 23.0%, 피양성종양은 8예로 30.8%이었으며 악성 난소종양이 4예이었다. 3. 입원시 내진소견과 종괴유무 판정의 정확도는 68예중 60예로 88.2%에서 내진과 초음파 단층촬영으로 각기 진단이 가능하였다. 초음파 검사중 위음성예와 내진소견이 위양성인 경 우는 각기 4예로 5.9%였다. 4. 초음파 단층상 위음성환자 4예는 각각 가능성 난소종양파열 1예, 난소출혈 1예, 자궁각임 신 1예 및 침윤성융모선종 1예이었으며 내진상 위양성 환자 4예는 골반결핵 및 심한 만성 골반염으로 인한 장관 및 부속기 유착등 염증성 변화가 2예이었고 고식적 제왕절개술 후 자 궁전벽과 복벽 간의 유착 자궁내 임신 1예 중복자궁 내 초기임신 1예였다. 5. 각종 종괴의 초음파 예측치와 수술후 실측치를 비교한 68예 중 초음파의 경우는 59예로 86.8% 내진치는 53예의 77.9%의 정확도를 보였다. 1. The 84 cases of study group were consisted of 28 cases (33.8%) for benign ovarian tumor, 4 cases (4.8%) for malignant ovarian tumor, 8 cases (9.5%) for inflammatory lesion, 20 cases (23.8%) for uterine lesions, 18 cases (21.4%) for related pathologic pregnancy and 6 cases (7.1%) for confirmation of intrauterine device. 2. Among the 54 cases of pelvic mass, the frequency in order were 26 cases of benign ovarian tumor, 20 cases of uterine tumor and 4 cases of malignant ovarian tumor, respectively. 3. Out of the 68 patients 60 (88.2%) had correct preoperative detection by both ultrasound and pelvic examination. There were 4 (5.9%) patients with false-negative ultrasound findings and 4 (5.9%) with false-positive pelvic examinations. 4. In 5 (11.8%) of the 68 patients in this study, ultrasonography revealed no pelvic mass. At the time of laparotomy it was found that the ultrasound reports were correct in 4 of these patients and incorrect in 4 . 5. In total cases of the 68 patients the size of the mass was reported by pelvic examination, ultrasound, and laparotomy findings. There was no significant difference in the accuracy of either preoperative method in estimation size.

한국 여성의 융모종양에 대한 화학요법

박찬무(CM Park) 대한산부인과학회 1972 Obstetrics & Gynecology Science Vol.15 No.11

분만수에 대한 융모종양의 발생빈도는 1:69(1.45%), 융모암은 1:258(0.38)이었다. This article is the report of trophoblastic tumor treated in the gynecological ward of The National Medical Center during 13 years, from January 1, 1959 to December 31, 1971. Trophoblastic tumors occured once in about 69 deliveries (1.45%) and choriocarcinoma once in about 258 deliveries (0.38%). The distribution of histopathological classification of total 214 cases were as follows: hydatidiform mole 98(45.7%) choriocarcinoma 57(26.6%) invasive mole 20(9.4%) unclassified 39(18.2%). Patients could be seen most frequently in 20th age group and more in multipara than in primipara. In 72 women with metastatic trophoblastic tumor, intensive chemotherapy with the folic acid antagonist "Methotrexate" (MTX) has led to complete remission in 39 patients (54.1%) but 10 patients died after temporary remission and 17 patients failed to show any response. The analysis of 72 metastatic trophoblastic cases treated with MTX, according to histopathological findings showed that 50% of 35 choriocarcinoma, 50% of 12 invasive mole, 85% of 13 hy6datidiform mole and 42% of 12 unclassified cases obtained complete remission of symptoms. The analysis of metastatic sites of 80 metastatic trophoblastic cases showed 65 pulmonary metastases, 22 pelvic mass and 21 vaginal metastases. Metastases in lungs and vagina simultanously in one patient were observed in 13 cases, which revealed the highest frequency of multiple metastatic sites in one patient. The effect of metastatic site on response to the chemotherapy showed that the patients with pulmonary metastases fared most favorable, pelvic mass in second and vaginal metastases most poor, and metastases in a single site showed better result than multiple sites in one patient. Among 39 complete remissions, 11 cases showed no relapse more than 5 years and 6 cases were within one year duration of complete remission The number of courses of MTX required to induce complete remission in 39 patients indicated from 1 to 5 courses, with a high frequency of complete remissions being induced by 2 to 3 courses. The apparent primary course of death in 11 autopsies available in the study showed that hemorrhage was the most frequent lethal mechanism. In 3 cases of 11 autopsies MTX toxicity appeared to play a contributory role in the death of the patient. The relationship between age and therapeutic response, number of gravidity and therapeutic response showed no singificance. The histopathological features were widely considered to have a decisive influence upon the utimate prognosis but this consideration seemed not to be equally applicable to the problem of the response to chemotherapy in such advanced cases as author`s series, which led us to place little prognostic reliance on the prior histopathological diagnosis in metastatic cases. The role of pior operation e.g. hysterectomy and ovariectomy in determining the type of response to chemotherapy showed that the presence or absence of the uterus and ovary appeared to play no significant role. Perhaps the most critical factor in the response to chemotherapy appeared to be the duration of the disease process prior to the onset of treatment and this study showed that patients treated within 4 months of the onset of the disease revealed markedly favorable prognosis and even in patients treated within 6 months revealed significant better outcome than those treated later than 6 months. The type of pregnancy immediately preceding onset of tropho- blastic disease showed little effect on the outcome of therapy in cases with established, metastatic disease in this study.