복강경하 난관복원수술 후 임신율에 관한 임상연구

이위현(Wee Hyun Lee),차선희(Sun Hee Cha),이미화(Mee Hwa Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. Method; During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+-4.3 years(mean+-SD; range 26 to 47 years). Result: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+-35.5 minutes) than for laparotomy(159.7+-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+-2.3 days for laparoscopy, 6.1+-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. Conclusion: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.

임신 중기 태아 맥락총 낭종 119예의 추적 조사: - 18번 삼염색체증과의 연관성 여부를 중심으로 -

이은혜(Eun Hye Lee),이유미(You Me Lee),신명철(Myung Choel Shin),민유선(Yu Seon Min),이상희(Sang Hee Lee),김현철(Hyeon Chul Kim),김종욱(Jong Wook Kim),이숙환(Sook Hwan Lee),이위현(Wee Hyun Lee),조진호(Jin Ho Cho),이정노(Chung No Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.7

목적 : 임신 중기 태아 맥락총 낭종의 임상적 의미를 알아보고자 하였으며 특히 18번 삼염색체증과의 연관성에 중점을 두었다. 연구 방법 : 1998년 3월부터 1999년 6월까지 4,948명의 단태 임산부에서 선별 초음파검사를 시행하여 132예의 맥락총 낭종을 발견하였다. 그 중 정밀 초음파검사와 추적 검사를 받은 119예를 대상으로 하였다. 단독 맥락총 낭종은 91예, 고위험군의 맥락총 낭종은 28예였는데, 단독 맥락총 낭종은 일반 산모의 태아에서 발견된 맥락총 낭종이면서, 정밀 초음파검사에서 다른 이상 소견이 없는 경우로 정의하였다. 태아 맥락총 낭종이 염색체 검사를 필요로 하는 고위험 산모에서 발견되거나, 일반 산모의 태아 맥락총 낭종이라도 정밀 초음파검사에서 다른 이상 소견이 있으면 고위험군의 맥락총 낭종으로 정의하였다. 염색체 검사는 39예에서 시행하였다. 단독 맥락총 낭종 집단과 고위험군의 맥락총 낭종 집단에서 낭종이 발견 및 소실 시기, 낭종의 크기, 양측성, 다발성 및 복합성을 비교하였다(t-test, chi-square test; p<0.05). 정밀 초음파검사, 추적 초음파검사, 염색체 검사 및 분만 결과를 알아보았다. 결과 : 맥락총 낭종의 발견 시기는 단독 맥락총 낭종 집단과 고위험군의 맥락총 낭종 집단에서 차이가 없었다 (19±2 vs 18±1주; p>0.05). 낭종의 크기(6.4 vs 6.2 mm), 양측성(60% vs 57%), 다발성(66% vs 57%), 및 복합성(8% vs 14%)도 차이가 없었다. 맥락총 낭종은 크기에 상관없이 소실되었으며 소실 시기도 차이가 없었다(25±3 vs 26±3주). 단독 맥락총 낭종을 가진 태아는 출생후의 소아과 진찰이나 양수 천자에서 모두 정상으로 밝혀졌다. 고위험군의 맥락총 낭종 28예 중에는 18번 삼염색체증이 2예, 21번 삼염색체증이 1예 있었다. 삼염색체증을 가진 태아들은 모체혈청 선별검사가 양성이거나 정밀 초음파검사에서 다른 이상 소견이 있었다. 나머지는 정상으로 밝혀졌다. 결론 : 맥락총 낭종이 초음파검사에서 다른 이상소견과 동반되어 있다면 염색체 이상의 위험도가 매우 높으므로 반드시 염색체 검사가 필요하다. 그러나 단독 맥락총 낭종을 가진 태아는 염색체 이상의 위험도가 매우 낮은 것으로 알려져 있고, 본 연구에서 18번 삼염색체증은 한 예도 없었다. 따라서 일반 산모의 태아에서 발견된 맥락총 낭종은 염색체 검사의 적응증이 아니라, 정밀 초음파검사의 적응증으로 인식해야 한다. Objective: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. Methods: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. Isolated CPCs were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. CPCs in high-risk population were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; p<0.05). We evaluated the findings of detailed and follow-up ultrasonography, karyotypes, and final outcomes of pregnancy.Results: Gestational age at time of detection was not different in both groups of isolated CPCs and CPCs in high-risk population (19±2 vs 18±1 wk, p>0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25±3 and 26±3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal.Conclusion: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.

방광질중격에 재발한 평활근종 1 예

이용희(Yong Hee Lee),이현행(Hyun Haing Lee),배병선(Byung Sun Bae),신명철(Myung Chul Shin),이위현(Wee Hyun Lee),권계원(Kye Weon Kwon) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

Leiomyoma of vagina is relatively rare benign tumor. And majority of these lesions occur in labia major and anterior vaginal wall. The recurrence of this tumor is extremely rare and its cellular atypism, mitotic activity, tumor size and contour are known as important factors in its recutrence. A case of recutrent leiomyoma causing urinary frequency in vesicovaginal septum was reported with a brief review of literature.

골반내 후복막강의 obturator fossa에서 발생한 양성 신경초종

이상걸(Sang Geol Lee),이은혜(Eun Hye Lee),심정연(Jeong Yun Shim),이찬(Chan Lee),신명철(Myung Choel Shin),이위현(Wee Hyun Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

The schwannoma is a benign neoplasm originating from Schwann cell. Solitary nerve sheath tumors such as benign schwannomas arising in the pelvic retroperitoneum are infrequently reported. Those tumors can indeed be misdiagnosed for other more common conditions both clinically and instrumentally. We report a very rare case of a benign retroperitoneal pelvic schwannoma of the obturator fossa, which was incidentally found and misdiagnosed as adnexal mass preoperatively in fifty one-years-old postmenopausal women.

태아 거대 임파종 2례

전익범(Leek Bum Chon),이상희(Sang Hee Lee),이위현(Wee Hyun Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

In this paper, two unusual cases of fetal giant lymphangiomas diagnosed before delivery is reported in 18 and 26-week pregnant woman. They were diagnosed by ultrasound. Although the cause of lymphangioma is not clearly established, they probably arise from a failure of the developing lymphatic tissue to establish normal connection with the draining lymphatics. These anomalies are most often cervical (about 70∼80%) but occasionally present in the axilla (about 10%), thorax and abdomen. Lymphangioma arising at posterior nuchal region is called cystic hygroma. Lymphangioma may be divided histologically into three types ; simple, cavernous or cystic. Ultrasound examination is essential method in prenatal diagnosis of fetal lymphangioma. The differential diagnosis of these fetal lymphangioma should include meningomyelocele, benign cystic teratoma, nuchal edema, encephalocele, and subchorial placenta cyst. About 60 to 70% of lymphangioma is accompanied with chromosomal abnormalities, and most common type is Turner's symdrome (40∼80%), but occasionally trisomy 21, 18, 13 and 47 XXY. But chromosomal studies of these cases showed normal findings. The 26-week fetus was IUFD at 29 gestational weeks and terminated by hysterotomy. Other 18-week fetus was terminated by vaginal delivery after intrauterine decompression.

응급자궁경부봉축술

김현철(Hyeon Chul Kim),신명철(Myung Choel Shin),이미화(Mee Wha Lee),이유미(You Me Lee),이위현(Wee Hyun Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Emergency cerclage commonly known as that performed in the setting of advanced cervical dilatation with bulging membranes and associated with significantly increased failure rates. We experienced a successful emergency cerclage for advanced incompetent internal os of cervix ( IIOC ). Pregnancy was prolonged and we delivered viable fetus. Hereby we report this case with the brief review of literature.

골반경하 전자궁적출술(TLH)과 골반경하 근막하 자궁절제술(CISH) 및 복식 전자궁 적출술(TAH)의 임상적 고찰

이상걸,차선희,신명철,김종욱,김현철,선우태원,이위현,조진호,이정노 대한산부인과내시경학회 2000 대한산부인과내시경학회잡지 Vol.12 No.1

골반 장기 탈출 환자에서 실리콘 환 페사리 이용에 대한 임상적 고찰

김현철,선우태원,이위현 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

목적: 본 연구는 골반 장기 탈출증 환자의 치료에 있어서 수술이 부적당한 경우 대안으로 실리콘 환 페사리 사용에 대한 효용성 및 안전성, 그리고 순응도에 대하여 알아보고자 시행되었다. 연구방법 : 1997년 1월부터 1998년 12월까지 골반 장기 탈출증으로 본원에 내원한 환자중 수술에 부적합하거나 수술을 거부한 환자 58명을 대상으로 순응도, 합병증, 자궁유무와의 관계등에 대하여 조사하였고 페사리삽입 및 착용유지실패군에 대해서는 따로 분석하였다. 결과 : 58명의 대상환자중 8명이 중도에 포기하여 13.7%의 탈락율을 보였고 29명(50%)에서 합병증을 보였다. 페사리실패의 주된 원인은 질점막궤양(4예)과 페사리의 탈출(3예)으로 나타났다. 페사리의 합병증 및 문제점은 다양하게 나타났는데 페사리의 탈출(10예), 질점막미란 및 궤양(9예), 질내감염(6예)등이었다. 자궁적출술을 시행한군과 자궁이 있는군사이에서는 페사리실패율 및 합병증발현율에서 별다른 차이가 나타나지 않았다. 결론 : 골반내 장기 탈출 환자중 수술에 부적합한 환자에 있어서 페사리는 간편하고 안전하며 효과적인 대안이 될 수 있을것이라 생각되며 추후 이에 대한 더 많은 연구가 필요할 것으로 생각된다. Objective : To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. Methods : This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. Results : Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. Conclusion: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.

출산전후의 요오드 섭취량과 산후 갑상선염과의 상관관계에 대한 임상적 고찰

차영수,조용욱,국진환,박필원,강명서,이위현,김유리,임정은,조여원 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.4

Background: Excessive iodine intake increases the occurrence of autoimmune thyroid disorders by enhancing immunogenecity of iodine-rich thyroglobulin, In Korea, most of postpartum women take a large amount of iodine-rich seaweed. Although the excessive iodine intake may affect the thyroid function, only a few reports were available concering iodine intake, especially on postpartum period. Methods: A prospective study was undertaken in 146 of normal delivered postpartum women. Dietary intake and urinary excretion of iodine, serum T3, T4, TSH, anti-TPO Ab and anti-Tg Ab were measured before and 1, 6, 12 and 24 weeks after delivery. Iodine intake was analyzed by one-to-one interview using 24hr recall and food frequency questionnaire. Results: 1. PPT was occurred in 6(10.3%) postparturn women, It presented as hypothyroidism alone in 1(16.7%), transient thyrotoxicosis followed by hypothyroidisrn in 3(50.0%), and thyrotoxicosis alone in 2(33.3%) of the follwed-up patients. 2. During pregnancy, no difference was found in age, serum T3, T4 and TSH between PPT and normal thyroid function group. 3. In PPT group, anti-TPO and anti-Tg Ab were significantly higher than those of normal thyroid function group during pregnancy, and their sensitivity for PPT was 40% and 33%, respectively. But there was no correlation between dietary iodine intake and the titer of thyroid auto-antibodies. 4. There was no correlation between pre and post-partum dietary iodine intake and occurrence of PPT. Conclusion: In Korea, the incidence of PPT was slightly higher than other nations. The sensitivity of thyroid auto-antibodies was too low to use for prediction of PPT. Pre and post-partum iodine intake had no effect on the occurrence of PPT and post-partum thyroid function. (J Korean Soc Endocrinol 12:541-549, 1997)