Mayer-Rokitansky-Kuster-Hauser 증후군의 2 예와 williams 수술 2 예

박영순(YS Park),이정호(JH Lee),김현수(HS Kim),김종우(CW Kim) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.2

Mayer-Rokitansky-Kuster-Hauser 증후군의 2 예와 williams 수술 We descrive two case of M.R.K.H syndrome and william`s operation were reviewed briefly. The Mayer-Rokitansky-Kuster-Hauser syndrome refers to the clinical entity consisting of - Normal female secondary sex charateristics - Normal external genitalia - congenital absence of vagina - A rudimentary uterus in the form of bilateral noncanaliculated muscular buds. - Normal tubes and ovaries with normal cytogenetic and endocrine evaluation

골반경으로 성선제거술을 시행한 남성호르몬 불감증후군 (완전형) 1 례

이정호,조남규,김판조,이은우 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.8

Androgen insensitivity syndrome is a genetic syndrome characterized by complete or partial resistance of end organs to the peripheral effect of androgen. patients have a male karyotype(46,XY) and bilateral testes. Appearance of the external genitalia depend on the degree of androgen insensitivity. In the complete from(Complete AIS), the external genitalia is normla female. In the incomplete from(Incomplete AIS), the external genitalia appearance varies from that of a virilized female to that of an undervirilized male with a short penis penis and hypospadia. The usual presenting complaint associated with complete AIS is an inguinal hernia in a female infant or primary amenorrhea. In incomplete AIS, the patient present with ambiguous genitalia in a neonate or later because of insufficient virilization during puberty. Recently we experienced one case of this syndrome and removed the gonad by pelviscopic surgery, so we report it with brief review of literature.

Multifire Endo GIA를 이용한 골반경 자궁적출술 (CISH) 의 임상적 고찰

이태성,조치흠,차순도,서영욱,윤성도,김종인,이정호 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.10

본 연구는 20명의 환자에서 골반경에 의한 CISH수술을 mulifire Endo GIA를 이용하여 시행하였다. 수술중 자궁부속기의 절단을 위해 multifire Endo GIA를 사용함으로써 suture ligation과 bipolar forceps보다 수술시간과 출혈 등을 줄일 수 있었고 자궁의 크기가 큰 경우에도 수술이 용이하게 되었다. CISH 수술의 장점으로는 절제된 자궁을 복강을 열지않고 적출하였으며, 자궁경부의 편평-원주세포 연결부를 제거하여 자궁경부암의 발생을 예방하였고 자궁경 부와 골반저부를 보존하여 환자의 빠른 회복과 통증이 적은 것을 볼 수 있었다. 앞으로 전 자궁적출술에 있어서 복식 전자궁 적출술보다는 저 침습적 골반경에 의한 수술로 전환해 나갈것으로 사료된다. Twenty patients underwent pelviscopic classical intrafascial SEMM hysterectomies (CISH) using multifire Endo GIA from March 1994 to December 1994 at the Department of Obstetrics and Gynecology Keimyung University. CISH method is pelviscopic supracervical hysterectomy with transvaginal cylindrical coring out of the cervical tissue using CURT. The advantages of the CISH method using CURT may be the preservation of the pelvic floor organ and minimally invasive surgery. Our method which is multifire Endo GIA to transect the infundibulopelvic ligament, makes facilitate the operating procedure and reduce the blood loss. the mean age of the patients was 41 years old. the indications of the surgery were uterine myoma(12 cases 60%), adenomyosis(8cases 40%). In the size of uteri, 8 gestational week-sized were 7 cases (35%), 10 gestational week-sized were 9 case(45%), 12 gestational week-sized were 3 cases (15%), 14 gestational week-sized was 1 case (5%). The mean hospitalization was 5.1 days and the mean estimated blood loss was 1.6gm/dl hemoglobin. the mean operating time was 186 minutes. Postoperative complications were as follows ; cervical stump hematoma(1), cone site hemorrhage(2), trocar puncture site hematoma(2). In conclusion, CISH operation using multifire Endo GIA not only makes the procedure safer for the patients but also facilitates surgery and reduces operating time of conventional CISH operation. The trauma to the patients is minimal, and organ preservation and function are optimal.

자궁내막증의 임상적 고찰

이태성,차순도,서영욱,이탁,이정호 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.6

1. 자궁내막증의 발생빈도는 개복수술을 한 예에서 2.8%였다. 2. 호발연령은 30대, 20대 순이었다. 3. 임상증상에 있어서 월경통 90.2%, 월경전 통증 80.0%, 성교통 29.2% 그리고 배변시의 통증이 36.9%나 되었다. 4. 불임증을 동반한 예가 49.2%였다. 5. 불임증을 동반한 예에서 불임기간이 5년이내가 68.8%, 6~10년이 21.9%였고, 불임을 동반하지 않았던 예에서는 최종임신에서 진단시까지의 기간이 6~10년이 36.4%, 11~15년이 33.3%로, 6년이상이 81.8%나 되었다. 6. 내진시의 소견으로 부속기에 고정된 종괴의 촉지가 44.7%, 자궁천골인대에 결절상 종괴 26.2%, 그리고 더그라스와에서의 경결이 15.4%촉지되었다. 7. 호발부위는 난소 76.9%, 자궁천골인대 52.3%, 자궁 35.4%의 순이었다. 8. 내막증의 병기와 임상증상 간에서 아무런 연관관계가 없었다. 9. 내막종의 경우에도 특징적인 임상증상이 없었으며, 다른 초기의 내막증의 증상과 차이가 없었다. 10. 자궁근종과 동반된 예는 15.4%였다. This is a clinical analysis of 65 cases of endometriosis diagnosed during laparotomies performed at the department of Obstetrics and Gynecology, School of Medicine, Keimyung University from Jan. 1986 to July 1988. The results are follow: 1. The incidence of endometriosis was 2.8 %, 65 cases among 2358 laparotomies. 2. The average age of the patients was 32.5 and the most frequent occurrence was noted in the group of thirties. 3. The symptoms comprised dysmenorrhea in 60.0 % of the case, pain just before menstruation in 30.9 %, dyspareunia in 29.2 %, and painful defication in 36.9 %. 4. Associated infertility combined with endometriosis was noted in 49.2 % of the cases. 5. The duration of infertility was less than 5 years in 68.8 % of the cases and the interval of diagnosis from the last pregnancy in non-infertility group was more than 6 years in 81.8 % of the cases. 6. The frequent pelvic findings comprised fixed mass at adnexa in 44.7 % of the case, nodular mass at uterosacral ligament in 26.2 %, and induration in cul-de-sac in 15.4 %. 7. The sites most frequently involved were ovary in 76.9 % of the cases and uterosacral ligament in 52.3 %. The other site were uterus, fallopian tubes, round ligament and bladder. 8. Clinical symptoms are no correlation with the extension of the disease. 9. Myoma was associated in 15.4 of cases.

태반조기박리에 대한 임상적 고찰

김종인,이정호,박성규,김판조,강석선,은명희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Abruptio placentae is the separation of a normally implanted placenta after the 20th week of gestation and before the birth of fetus. It is the one of third trimester obstetric hemorrhage disease that the need emergency treatment. Clinical investigation of abruptio placentae is needed for its early diagnosis and adequate treatment. This study was investigated of the 126 cases of abruptio placentae among 23,848 deliveries, which admitted to the Department of Obstetrics and Gynecology, College of Medicine, Keimyung University, during 5 years of period from January, 1992 to December, 1996. The results were as follows; 1. The incidence of abruptioplacentae was 0.53%. 2. In the timing of diagnosis, 50.8% of abruptio placentae was diagnosed before delivery. 3. Abruptio placentae occurred between 26 and 30 years old mostly. 4. The majority of abruptio placentae occurred between 33 and 37 weeks of gestational age(47.7%), and with occurred before 37 weeks was about 83.8%. 5. The incidence of unknown etiology was 56 cases(44.4%) and pregnancy induced hypertension was 48 cases(38.1%). 6. The most common symptom and sign in this study was vaginal bleeding(66.6%). Intrauterine fetal death was found in 32.5% and uterine tenderness in 25.4%. 7. As for the distribution of birth weight 33 cases(25.5%) were 1,500 to 2,000 gm and 22 case(16.9%) were 2,000 to 2,500 gm. The weight of neonates was under 2,500 gm in 74.7%. 8. Perinatal mortality and morbidity were closely related with grade of placental abruptio and gestational weeks. 9. In 56 cases(44.5%) blood transfusion was necessary. 10. The complication of abruptio placentae of this study were followed. Couvelaire uterus occurred in 15 patients, disseminated intravascular coagulation in 12 patients. The others were retinal detachment, acute renal failure, pulmonary edema. 11. Cesarean birth was performed in 43.7% and vaginal delivery in 56.3%. Fetal distr-ess was most common indication of cesarean birth. 12. Perinatal mortality rate was 51.6% including stillbirth(40.8%) and neonatal death (12.8%).

산전 초음파로 진단된 골형성부전증 (II) 1 례

김종인,이정호,박중규,정철재 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.6

최근 저자들은 재태기간 32주 4일에 산전초음파로 진단된 골형성부전증(type II) 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The osteogenesis imperfecta is a rare congenital disease characterized with multiple bone fracture, blue sclera progressive deafness, abnomalities of dentition, loose jointedness and skin. We recently experienced a case of osteogenesis imperfecta (II) diagnosed in utero by ultrasonogram and confirmed after delevery, we report here with a brief review of the literature.

조기파수된 태아막의 초미세구조의 변화

조치흠,윤성도,이정호,이민용,권건영 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.2

조기파수의 정의는 일반적으로 진통이 시작되기 전에 파수가 되는 현상을 말하나 파수와 진통개시까지의 소위 잠복기는 학자에 따라 1-12시간 사이를 두고 있다. 조기파수의 원인은 단 한가지의 요인보다 복합적인 결과로 판단되고 있다. 태아막은 양막과 융모막으로 구성되어 있는데 양막은 태아막의 해면층에는 강도를 유지하는데 보다 더 중요한 교원질 섬유들이 존재하며 해면층은 고정된 융모막보다 양막이 보다 자유롭게 운동하게 해준다. 저자들은 계명대학교 동산병원 산부인과 분만장에서 채취한 정상산모와 조기파수 산모의 태아막을 대상으로 투과전자현미경과 주사전자현미경을 이용하여 관찰한 결과 조기파수된 군에서 뚜렷한 초미세구조의 변화를 얻을 수 있었다. 즉 양막세포 표면의 편평화, 세포간 간격의 확대 및 부종, 세포내 소기간등의 변성, 세포배치의 불균형, 세포끼리의 융합으로 덩어리 형성, 섬유모 세포의 출현 등을 볼 수 있었다. 그러나 이러한 태아막의 초미세구조의 변화를 조기파수의 원인이라기보다는 결과로 인식되었다. 교원질 섬유의 변화에 대한 보다 자세한 연구를 위해서는 면역조직화학적 방법이 필요할 것으로 사료된다. Premature rupture of membranes(PROM) is the single most common diagnosis associated with premature delivery and neonatal complications requiring admission to a neonatal intensive care unit. But there remains no clear answer as to how the disease occurs. Authors compared the ultrastructural findings of amnoiotic membranes of patients with gestation 36-40 wks PROM with those of uncomplicated term pregnancies. The results are as follows. Transmission electron microscopic findings: In uncomplicated group, surface amniotic epithelium showed regular, uniformed round shape with well developed microvilli and some secretory products in the cytoplasms. Intercellular junctions had uniform gaps and structures. Basement membranes were thin, stromas were loose and no fibroblast was seen. In PROM group, there were flattened surface amniotic epithelia with partly dimpling, destroyed and flattened changes. Scanning electron microscopic findings: In unicomplicated group, surface epithelium showed well structural arrangement, round to polygonal shape and intact intracelular junctions with well developed microvilli. In PROM group, there were flattened and/or depressed amniotic epithelia with multifocal loss of microvilli. Cellular shape and size were irregular, partly conglomerated and unorganized.

태반조기박리의 진단에 있어서 모체혈청 CA 125의 유용성

김기홍,김종인,이정호,이승민,김학준,서영우 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

The diagnosis of abruptio placentae is frequently difficult despite advanced diagnostic tool because of symptomatic diversity, so additional diannostic parameter would be useful. Maternal serum CA 125, which is derived from decidua, shows an increase by the tenth weeks and then decreases, remaining low level until delivery. However, within 1 hour after term delivery, CA 125 level shows a second increase, probably because of decidual disruption. Serum CA 125 level was measured in 45 patients between 29 and 41 weeks gestation who were seen with vaginal bleeding and in 30 control patients of same gestational age. Mean(±SD) CA levels were higher(p$lt;0.05) among patients with abruptio placentae(61.2±52.9U/ml) than among those with bleeding due to placenta previa(17.4±8.5U/ml) or control patients(20.3±21.3U/ml). Mean(±SD) serum CA 125 level in 17 control patients within 6 hours postpartum(81.7±102.6U/ml) were higher than those among patients with palcenta previa or normal pregnancy(p$lt;0.05). Sensitivity and specificity of maternal serum level of CA 125 for diagnosis of abruptio placentae were 73% and 92% on cut off level of 30U/ml, respectively.

17 세 소녀에 발생된 미분화배세포종의 1 례

김종우,이신애,이정호,최응철,이지영 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.4

저자는 17세의 소녀에서 난소에 발생한 미분화배세포종 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. A case of ovarian dysgerminoma in 17 year-old girl is reported, and its literatures are reviewed briefly.

산전 초음파로 진단된 태변복막염

권상훈,김종인,이정호,송진화 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.6

최근 계명대학교 의과대학 산부인과학교실에서 산전 초음파검사상 태아복수, 석회화, 음낭수종을 동반한 태아복막염으로 진단된 임신부에서 임신 34주 3일에 제왕절개술을 시행하여 분만된 신생아를 장문합수술을 시행하여 현재 특이사항없이 성장하고 있는 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The meconium peritonitis is rare and has been difined as a chemical inflamation or foreign-body reaction fo the peritoneum caused by the escape of sterile meconium into the peritoneal cavity of the fetus or newly born infant, resulting from the prenatal small bowel perforation associated with or without obstructive lesions and malformation, had been reported by Simpson (1938) and other authors. Prenatal ultrasonographi cdetection of the meconium peritonitis allow the preparation for the proper management which should be decreased the mortality and morbidity of the neonate. Recently, a case of meconium peritonitis diagnosed by ultrasonography at 33 gestational weeks was experienced. We present this case with a brief review of literature concerned.