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.

자궁 동정맥기형의 색전술 1 예

이찬,이유미,이정노,이은혜,이병희 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

자궁의 동정맥기형은 드문 질환이지만 대량의 질출혈을 유발할 수 있다. 과거에는 자궁적출술이 유일한 진단법이자 치료법이었으나 최근에는 여러 가지 영상 기술의 발달로 인해 자궁 동정맥기형의 비침습적인 진단이 가능하게 되었으며 특히 카테타를 통한 자궁동맥 색전술은 최상의 치료법으로 인정받고 있다. 저자들은 자궁동맥의 코일 및 아교 색전술로 완치된 자궁 동정맥기형 1예를 경험하였으므로 관련 문헌 고찰과 함께 보고하는 바이다. Uterine arteriovenous malformations [AVMs] are rare cause of massive vaginal bleeding. In the past, hysterectomy had been the only method of diagnosis and treatment. With advent of many imaging modalities, noninvasive diagnosis of AVMs is possible and the transcatheter embolization has been accepted as a treatment of choice. We describe a case of uterine AVM presented with intractable vaginal bleeding and successful transcatheter embolization with coils and glue.

다운증후군 산전 선별검사방법의 효능비교

이숙환,이용원,김경률,전혜선,이정노,차광은,백진영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test. Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, β-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.

난관복원수술 후 임신율과 임신에 영향을 미치는 인자에 관한 연구―1008 예에 대한 임상적 고찰―

이위현,윤태기,차선희,성혜리,이우식,박원식,이정노 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

난관복원수술 후에 임신 결과에 영향을 줄 수 있는 예후인자들을 살펴보고자 1989년 1월부터 1994년 4월까지 5년 3개월간 미세난관복원수술을 시행받은 1008예를 검토하여, 그 중 1년 이상 추적 관찰이 가능했던 764예를 대상으로 다음과 같은 결과를 얻었다. 1. 난관복원술을 받게 된 이유로서는 아이를 더 가지려는 경우(44.5%), 자녀의 잃음(36.8%), 재혼(18.7 %) 등이 주 원인이었다. 2. 대상 환자의 평균 연령은 34.1세였으며, 그들 중 복강경 전기소작으로 불임시술을 받았던 경우가 51.4% 였다. 3. 난관문합시술의 가장 흔한 부위는 협부-팽대부 (66.8%)였으며, 다음으로 협부-협부, 자궁각-팽대부의 순 이었다. 4. 복원수술 후의 잔여 난관의 길이는 71.5%에서 4.1cm 이상을 보였다. 5. 복원수술 후의 임신율은 75.0%를 보였고, 그 임신의 결과 만삭분만이 80.5%, 분만안된 경우가 11.2%, 조산 0.3%, 자궁내 태아 사망 0.3%, 자연유산 4.9%, 그리고 자궁외임신이 2.9% 였다. 6. 기왕의 불임수술 방법과 난관문합시술의 위치 그리고 술후의 잔여 난관의 길이에 따른 임신율의 유의한 차이는 없었다. 7. 수술 후 연령별 임신율은 40세 이상에서 통계적으로 유의한 감소를 보였다(p=0.0001). 8. 수술 후 임신까지의 평균 기간은 4.8개월이었으며, 4 cm를 기준으로 하였을 때 난관의 길이에 따른 임신율의 차이는 없었다. 결론적으로, 본 연구에서는 환자의 연령이 임신에 영향을 미치는 중요한 요인으로 사료된다. Objective: The purpose of this study is to evaluate the factors influencing the pregnancy outcomes of microsurgical tubal reanastomosis. Study design: During 64 months from Jan. 1989 to Apr. 1994, 1008 cases of microsurgical tubal reversal were performed and 764 cases of them were followed up and analysed retrospectively for more than 1 year postoperatively. Results: The overall pregnancy rate was 75.0%, ectopic pregnancy was 2.7%(not involved in overall pregnancy rate) and spontaneous abortion was 4.9%. No statistical differences were found in pregnancy rates according to the method of previous sterilization, the site of tubal reanastomosis and postoperative tubal length. The tubal length did not influence the mean interval from operation to pregnancy and pregnancy rate. But the pregnancy rate decrease was statistically significant at the age of over fourty. Conclusions: The age was the only factor influencing the pregnancy outcomes of microsurgical reanastomosis of tubal sterilization.

산전 초음파로 진단된 태반혈관종 7 예

차선희,안희정,이정노,권태희,박용현 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

저자들은 7예의 태반 혈관종을 산전 초음파검사에서 진단하였고 병리학적으로 확진되었기에 문헌 고찰과 함 께 보고하는 바이다. Since the placenta is an organ composed of blood vessels, it is not surprising that its primary neoplasm would be a vascular tumor. Placental tumors, primary or secondary, have been known to interfere with placental function. Chorioangioma(primary tumor of the placenta), which is the most common of them, occurs with an incidence for clinically significant ranges from 1∼2.8:10000 births. These tumors are benign and are not usually associated with clinical sequelae unless they are larger than 5cm in long diameter. About one third of the large chorioangiomas may be associated with the maternal and fetal complications. For diagnosis of these lesions, the ultrasonography was used. If the chorioangioma is suspected, color doppler study is informative to confirm the presence of the vascular channels. We reviewed ultrasonograms and clinical records of seven patients who had been diagnosed as placental chrioangioma. The appropriate diagnostic tests and treatment can then be initiated in order to prolong gestation and decrease fetal mortality and morbidity.

중복자궁의 일측 반자궁에서 발생한 자궁내막암 1 례

조진호,안희정,장성운,이용원,이정노,김병성,차성순 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

Endometrial adenocarcinoma in a double uterus has rarely been reported. We had a very rare case of double uterus with endometrial adenocarcinoma involving one hemiuterus and endometrial hyperplasia involving another hemiuterus. By report this case, we want to share our experiance. The abnomal anatomy of the uterine cavities could have made adequate biopsy difficult and endometrial cancer is clinically suspected but histology fails to confirm the diagnosis.

복강경하 미세 난관복원수술에 대한 임상적 고찰

윤태기,차광열,차선희,성혜리,이정노 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

저자들은 1993년 12월부터 1994년 12월까지 차병원 불임센터에서 33예의 복강경하 미세 난 관복원수술을 시행하여 다음과 같은 결과를 얻었다. 1. 복강경하 미세 난관복원수술의 임신성공율은 73.3%(22/30) 이었고 이중 4명은 이미 분만 되었고 3명은 임신초에 자연유산되었고, 15명은 현재 임신이 지속중이다. 2. 불임시술의 종류에 따른 수술예는 ring이 19예, cautery는 9예, pomeroy는 5예였으며, 임신 성공예는 각각 11예, 7예, 4예였다. 3. 난관의 복원부위에 따른 수술에는 cornual-isthmic 3예, isthmic-istmic 3 예, cornual-isthmic 3예, isthmic-ampulla 24예, cornual-ampulla 2 예, ampulla-ampulla 1예였으며 임신예는 3예, 2 예, 14예, 2예, 1예였다. 4. 복원수술 후 난관의 길이에 따른 수술예는 4cm 이하에서 6예, 5cm는 3예, 6cm 이상에서 는 24예였으며 임신예는 각각 4예, 1예, 7예였다. 5. 복원수술후 임신까지의 평균기간은 2.1+-0.3개월이었고 본 추적 기간중 자궁외 임신은 한 예도 없었다. 이상의 결과로 보아 복강경한 미세 난관복원수술은 비교적 짧은 추적기간임에도 불구하고 높은 임신율을 나타내었고, 복강경한 수술이 개복술에 비하여 여러 장점이 많이 있음을 감 안할 때 향후 수술기법의 발달과 미세수술기구가 더욱 개발된다면 이 방법이 매우 유용하게 시행될 수 있을 것이라 사료된다. We evaluated 33 cases of laparoscopic microsurgical tubal anastomosis performed between December 1993 and December 1994 and the results are as follows; 1. The previous tubal sterilization method was bipolar cauterization in 9 cases tubal ring in 19 cases , and 5 cases of pomeroy method. 2. The anastomosis site in the favorable tube was isthmic-istmic in 3 cases , cornual isthmic in 3cases , cornual-isthmic in 3 cases isthmic-ampulla in 24 cases , cornual-ampulla in 2 cases , and ampulla-ampulla in 1 case. 3. The overall pregnancy rate was 73.3%(22/30) in a 4 month follow up period. 3 cases were excluded from pregnancy rate because 2 were in premartital status and one was lost during follow up. 4. The mean interval to conceiver from the operation was 2.1+-0.3 months 5. There was no ectopic pregnancy during our follow up period. 6. There were no intraoperative or postoperative complications . Considering the high pregnancy rate inspite of the short follow up period in our experience, this procedure could certainly replace the conventional open microsurgery.

태아수종을 동반한 Klinefelter증후군 태아 1 예

계정웅,조진호,장성운,이정노,김병성,조은미 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7

Nonimmune hydrops fetalis(NIHF) is a heterogenous disorder resulting from a vast number of underlying pathologies. Chromsomal abnormalities underlie a large percentage of cases of NIHF in most series. There are many reports identifying the association of Turner syndrome and Trisomy 21, 18, 13 with NIHF, but few reports about Klinefelter syndrome. In this article, we experienced a case of Klinefelter syndrome combined with hydrops fetalis and report the case with brief review of literature.

선천성 질결손증 환자의 질성형술 6 례

김인현,안재영,전혜선,이정노,조성덕 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.1

Mullerian agenesis or dysgenesis, rare developmental anomaly presenting as primary amenorrhea, is characterized by absence of vagina and absence or rudimentary development of the uterus. Anatomic anomalies of the axial skeleton and kindney often accompany this psychologically devatating condition. There are various methods of surgical treatment for congenital absence of the vagina. The six cases reviewed in this paper were all treated with McIndoe technique. All of 6 women experienced satisfactory sexual activity and were satisfied with vaginal depth following vaginal creation using a split thickness skin graft technique. Despite the existence of several alternative methods, the McIndoe technique is a relatively simple and highly successful procedure and hence is still prefered by many surgeons.

SEMM방식의 골반경 자궁적출술 (CISH) 300 예에 대한 임상적 연구

김인현,정창조,조진호,김종욱,신명철,김경률,이정노 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

Laparoscopic hysterectomy, introduced by Reich et al in 1988, has proven to be an effective alternative to abdominal hysterectomy for women. Several modalities were introduced by some laparoscopists, among which the supracervical modality was particularly suitable for laparoscopic surgery because it has some advantages. The surpracervical hysterectomy requires less dissection of the bladder and the technique minimally alters the anatomy and integrity of the pelvic floor and vagina, therefore the risk of bleeding, surgical injuries to the bladder, ureters and lower intestinal tract were decreased. These factors may be responsible for the apparently less compromised bladder and sexual Function and decreased long term morbidity. The purpose of the study described below was to show that laparoscopic supracervical hysterectomy can be performed safely with minimal morbidity, and to establish the validity of replacing the vast majority of traditional abdominal hysterectomies. During the period October, 1992-June, 1996, 300 women underwent Classical Intrafascial SEMM Hysterectomy(CISH) at Cha Hospital, Seoul, Korea and KyungHee Bundang Cha Hosptial, Seongnam, Korea. Most common age groups were 41~50, and average age of patients was 43.2 years old. Most common parity groups was 2, and average parity was 2.4. Myoma and adenomyosis of uterus were common preoperative surgical indications. Most common uterine size was 8~10 weeks gestational size. The common operation time ranged from 151~180 minutes with a mean of 156 minutes. The common Hgb loss range was 1.5~1.0gm/dl, and average was 0.78gm/dl. The common hospitalization period were 5~6 day with a mean of 5.9days. The complications were 23 cases, among which intra and postoperative bleeding were most common.