한국형 자궁경부 촬영진 ( New Cervicography ) , 세포검사 그리고 HPV-DNA 검사를 이용한 새로운 자궁경부암 검진 모델 ( Model ) 개발

김승조(SJ Kim),박찬규(CK Park),이효표(HP Lee),남궁성은(SE Namkoong),강순범(SB Kang),서호석(HS Saw),이재관(JK Lee),김수녕(SN Kim),김재원(JW Kim),배석년(SN Bae),김찬주(CJ Kim),이근호(KH Lee),이선영(SY Lee),김인호(IH Kim),이찬(C Lee),이정노(JN Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : The false negative rate of conventional cytology is reported to range from 18 to 45%. It is necessary to develop more effective screening strategies that would ideally be more accurate than conventional cytology. This study is designed to investigate the potential of conventional cytology, cervicography, HPV-DNA testing and their combinations as primary screening techniques for cervical neoplasia. The purpose of this project is to develop the models and guidelines for screening tools of cervical cancer of the uterus by evaluating sensitivity, specificity and cost-effectiveness of all the screening methods. Study design : We conducted a screening of random sample of women who visited the department of OB-Gyn. of five different major university hospitals such as Catholic University Hospital, Korea University Hospital, Seoul National University Hospital, Yeonsei University Hospital and Pochon CHA University Bundang CHA Hospital, from May 1, 1996 to April 30, 1999. In a cohort women with an age range of 20 to 70 who underwent routine cytologic screening at Catholic University, Hospital Bundang CHA General Hospital and local clinics from April 1, 1996 to Decomber 31, 2000. cervicography (n=417,125) and testing for HPV-DNA (n=1,347) by the hybrid capture assay were studied for the ability of the cervical cancer screeuing. A new cervicography system with Kim's classification which was developed by Prof. Kim Seung Jo as an adjunctive method for the cervical cancer screening was applied in this cohort study. And then, accuracy, effectivencess, cost-effectiveness of the single or combined screening method were analysed. Result : Sensitivity and specificity of Pap smear were ranged from 55.6% to 83.1% and 72.8% to 88.3% respectively. The combination of Pap smear and cervicography had sensitivity from 89.7% to 98.6%, specificity from 68.2% to 93.2%. With combination of Pap smear, HPV DNA test and cervicography, sensitivity became also highest accuracy among all screening methods from 92.8% to 98.8%. Considering medical charges for diagnosis and social cost occurred by false positive and false negative results, the most cost-effective diagnostic modality was thought to be the combination of Pap smear and cervicography(91,433 won). In patients who were diagnosed as LSIL, colposcopic examination confirmed progression to high grade intraepithelial lesion(HSIL) in 10.7% patients, persistence of LSIL in 55% patients during the 3 year follow-up period. Accuracy of the screening for cervical cancer and CIN can significantly be improved by cytology with new cervicography rather than cytology alone. We concluded that cervicography can be important adjunctive tests for cervical cytology, improving the effectiveness of cervical screening by allowing a more sensitive detection of cervical neoplasia.

선천성 자궁기형 37 예에 대한 임상적 고찰

권용일,박태철,이진우,권동진,김찬주,황지영,김기범,이근호,류진희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

목적: 선천성 자궁기형은 여성 생식기 기형 중 가장 흔한 것으로 수정능력과 산과적 문제점을 유발한다.이에 저자들은 8년간 37명의 자궁기형 환자를 대상으로 생식력, 산과적 문제점, 자궁성형술과의 관계를 밝히고자 하였다. 연구 방법 : 1990년 1월부터 1997년 12월까지 8년간 가톨릭대학교 의과대학 강남성모병원 및 의정부 성모병원 산부인과를 방문한 자궁기형을 가진 환자 37명을 대상으로 자궁기형의 빈도, 진단 방법, 태위와 생식력, 자궁성형술과의 관계를 조사하였다. 분석 자료로는 병원통계자료, 의무기록, 분만기록, 수술기록, 방사선 기록등을 참조하였다. 결과: 자궁기형의 빈도는 400 분만 중 1예(0.25%), 외래환자 1237명당 1명(0.08%)에서 발견되었다. 대부분의 자궁기형은 자궁난관조영술(37.8%), 제왕절개술(21.6%), 그 이외의 수술적 방법으로 진단되었고 대칭성 자궁기형이 전체의 97.3%를 차지하였다. 98예의 임신 중 유산 46.9%,조산 10.2%,만삭분만 40.8%, 자궁외 임신 2.1%였다. 자궁기형 환자의 태위는 둔위 14%, 횡위 2% 였으며 92%의 자궁기형환자가 제왕절개 분만을 하였다. 자궁성형술을 시행한 11명 중 6명에서 신생아를 분만하으며 쌍각자궁 5예 중 4예에서 수술 후 신생아를 분만하였다. 일차성 불임인 2예에서는 수술 후 1년 이상의 추적관찰에도 불구하고 임신이 되지 않았다. 결론: 자궁기형의 분포는 대칭성 기형이 대다수를 차지하고 있으며 불임보다는 자연유산과 연관이 있고 유산의 빈도는 쌍각자궁에서 가장 높았다. 일차성 불임이 없는 대칭성 자궁기형에서 자궁성형술을 시행하였을 경우 생식력을 호전시킬 것으로 생각된다. Objective: Congenital uterine anomalies are most common of the female reproductive system. The anoamlies are mainly responsible for infertility and obstetric problems, as opposed to other congenital anomalies in the female reproductive system. Clinical evaluation of 37 patients with uterine anomalies was performed to determine the relationship of anomalies to reproductive performance, obstetric risks, and surgical reconstruction (metroplasy) during 8 years. Method: Hospital statistics were used to identify patients with Mullerian anomalies who visited outpatient department between Jan. 1990 and Dec. 1997 of Kangnam and Uijongbu St. Mary`s Hospitals. Detail data were obtained by reviewing hospital charts, delivery records, operative reports and radiologic studies. Results: The incidences of uterine anomalies are 0.25% (1/400 deliveries), and 0.08% (1/1237 outpatients). Symmetrical anomalies constituted of 97.3% of the cases. Most uterine amomalies were diagnosed by means of hysterosalpingogram (37.8%), cesarean section (21.6%) and other operative procedure. Spontaneous abortion (46.9%), preterm delivery (10.2%), term delivery (40.8%), ectopic pregnancy (2.1%) occurred in those patients. The highest incidence of abortions (56.7%) occurred in the group of bicornuate uterus. The incidences of breech presentation and transverse lie were 14% and 2% respectively. Ninety two percent of the deliveries were performed by cesarean section. Of the 11 patients who performed metroplasty, 6 had a living children. For 5 patients with repaired bicornuate uterus, 4 (75%) had a living childern. Two cases of primary infertility was not conceived after metroplasty during over 1 year follow up period. Conclusion: Congenital uterine anomalies are more often associated with spontaneous abortion than infertility. Conventional metroplasty seems to be improving reproductive outcome in women with symmetric uterine anomalies without primary infertility.

수술 및 진단적 복강경수술 450 예에 대한 임상적 고찰

권용일,박태철,이진우,김수평,권동진,이근호,류진희,상미란 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

목 적: 산부인과 영역에서의 복강경술은 창상이 적고 유착이 적으며 수술후 통증 및 합병증이 적고 회복이 빨라 비용이 절감된다는 장점뿐 아니라 미용학적인 잇점이 있으므로 점차 개복술을 대체하여 치료영역이 확대되고 있는바 본 연구는 가톨릭대학교 의정부 성모병원 산부인과에서 1997년 1월부터 1998년 12월까지 시행한 복강경수술 450예를 분석하였다. 연구방법: 1997년 1월부터 1998년 12월까지 가톨릭대학교 의정부 성모병원 산부인과에서 복강경수술을 시행받은 환자 450명의 외래 및 입원기록을 검토하였다. 검토항목으로 환자의 연령, 출산력, 복강경수술의 적응증, 수술종류 및 시간, 입원기간, 합병증을 분석하였다. 결 과: 1997년 1월부터 1998년 12월까지 가톨릭대학교 의과대학 의정부 성모병원 산부인과에서 시행한 450예의 복강경술을 분석하여 다음과 같은 결과를 얻었다. 1. 환자들의 평균연령은 33.3세였다. 2. 환자들의 평균 출산력은 1.07회였고 초산부가 37.3%였다. 3. 복강경술의 적응증은 총 450예중에서 난소낭종이 156예[34.7%]로 가장 많았고 그외 자궁근종이 96예[21.2%],자궁외임신이 61예[13.6%], 자궁내막증 57예[12.7%]였다. 4. 복강경수술의 방법은 수술적 복강경술 총 376예 중 낭종절제술이 80예[27.0%], 복강경하 자궁 적출술 58예[19.5%], 복강경하 질식 자궁 적출술 50예[16.9%], 난관절제술이 42예[14.1%], 난소난관절제술 38예[12.8%]이었다. 5. 환자들의 평균입원기간은 3.06일이었다. 6. 수술시간은 복강경하 질식 자궁 적출술의 경우 평균 90분∼150분이 소요되었고 복강경하 자궁 적출술의 경우는 60분-120분, 그외 대부분의 경우에서는 60분미만이었다. 7. 복강경수술후의 합병증은 450예 중에서 8예가 있었고 이는 투과침에 의한 장손상, 자궁거상기에 의한 자궁손상, 상처부위 혈종, 감염, 단시간의 배뇨장애, 술후 장마비증, 재출혈등이었다. 8. 불임증으로 수술적 복강경술을 시행받은 환자들 28예중 10예에서 임신에 성공하였다. 결 론: 이상의 결과로 부인과 질환의 진단과 치료에 있어서 복강경술의 이용은 매우 유용하며 점차로 개복수술을 대치하는 상황으로 앞으로의 이용을 점차 극대화 해나가야 한다. Objective : Pelviscopic surgery has been reported to reduce inpatient hospital time and cost in addition to minimizing tissue damage and bleeding. To evaluate the efficacy of pelviscopic surgery in gynecologic patients, we reviewed and analyzed 450 cases of operative and diagnostic pelviscopy from January, 1997 to December, 1998. Methods : From January, 1997 to December, 1998, total 450 patients were received laparoscopic surgery on dept. OBGY of Uijungbu St. Mary`s Hosp. We reviewed the chart and analyzed these cases about age, parity, diagnostic name, operation title, duration of hospitalization, side effect, operation time. Results : The results of this study were summarized as follows : 1. The average age of patients was 33.3 years old and the great incidence occurred in 26∼30 years group [28.4%]. 2. The average parity of patients was 1.07 . 3. The common indication were ovarian cyst[34.7%], myoma uteri [21.2%], ectopic pregnancy[13.6%], pelvic endometriosis[12.7%]. In diagnostic pelviscopy, the most common indication was infertility[43.2%] and ovarian cyst [40.4%] was the most common indication in operative pelviscopy. 4. The major types of operative pelviscopy were cystectomy, total laparoscopic hysterectomy[TLH], laparoscopy assisted vaginal hysterectomy[LAVH], salpingectomy,adnexectomy, electrocauterization. 5. The mean duration of hospitalization was 3.06 days. 6. The major complication of surgery were intestinal injury, postoperative paralytic ileus, bleeding at resection site, but, they were controlled without difficulty. Conclusion : Now, the use of pelviscopic surgery are increased in gynecologic surgery. Pelviscopic surgery is useful and recommended for the treatment of gynecologic disease, because this is safe and has many advantages.