난소가 적출된 임신성 융모성 질환에서 고원정체를 보인 p-hCG의 완전관해에 관한 증례

김태진,현우영,심재욱,이기헌,정환욱,강옥림,함경렬,이문섭,임경택,박종택,박인서 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum β-hCG assays and the persistent disease may be indicated when the serum β-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on β-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of β-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum β-hCG assay plateaued at a low level atotal abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with β-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative β-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of β-hCG in those patients were considered to be result of LH cross-reactivity on β-hCG assessment. It is concluded that whenever the assay of β-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.

미세난관복원수술 후 누적 임신율에 관한 임상적 고찰

홍수정,전종영,궁미경,백은찬,유근재,송지홍,현우영,이문섭,함경렬,이경상 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

목적: 미세난관복원수술에 영향을 미치는 인자와 추적 관찰 기간 중 누적 임신율과 임신가능성을 알아보고자 하였다. 연구 방법: 1993년 4월부터 1995년 3월까지 삼성제일병원 불임클리닉에서 한 사람의 수술자에 의해 미세난관복원수술을 받은 119명을 대상으로 logistic regression analysis와 life-table analysis를 하였다. 결과: 추적 관찰된 대상의 전체 임신율은 77.9%(67/86)이였고 여기에는 생화학적 임신 1.2%, 자궁외임신 4.7%, 자궁내임신 72.1%이 포함된다. 임신율에 영향을 미치는 인자는 수술 후 난관 길이와 추적 관찰기간이었다. 수술 후 24개월 내에 임신할 가능성은 0.75이었고 수술 후 임신되기까지의 median interival은 6.6개월이었다. 결론: 수술 후 24개월 내에 임신할 가능성은 0.75이고, 수술 후 난관 길이가 임신율에 미치는 중요한 인자였으며 추적 관찰기간이 길수록 누적 임신율은 증가하였다. Objective: To evaluate what factors can influence the pregnancy outcome of the patients who underwent microsurgical of tubal sterilization and to calculate cumulative preganncy rate and probability of pregancny by period of follow-up. Design: Retrospective clinical study. Patient(s): One hundred nineteen patients who had sterilized and had operated microsurgical tubal reversal by one operator in our hospital between April 1993 and March 1995. Main Outcome Measure(s): Clinical characteristics of patients, influencing factors and cumulative pregnancy rates by logistic regression analysis and life-table analysis. Results: Pregancny outcomes were identified in 72.3% of the total patients (86/119). The overall pregancny rate was 77.9% (67/86), which included biochemical pregnancy (1/86, 1.2%), ectopic pregnancy (4/86, 4.7%) and intrauterine pregnancy (62/86, 72.1%). The factors influencing pregnancy outcome in this study by logistic regression analysis were tubal length after operation and interval from operation to achieving pregnancy. The probability that pregnancy would occur within first 24 months in total patients was 0.75. The median interval from tubal reversal to pregnancy was 6.6 months. Conclusion: The overall probability of pregnancy was 0.75 within first 24 months. The tubal length reconstructed after operation was the major factor affecting the pregnancy outcome according to result of this study.

자궁경부 세포진검사에서 저등급 편평상피내 병변 (low grade squamous intraepithelial lesion)을 지닌 여성의 임상적 고찰

김태진,심재욱,이영아,박종택,정환욱,박인서,임경택,이기헌,김희숙,강옥림,함경렬 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

The purpose of this study was for clinical evaluating those women with low grade squamous intraepithelial lesions (LSIL) who have been detected on Pap smears. We analyzed 279,270 Pap smears, from January 1994 to August 1997, of which 703 cases were identified as LSIL, and their medical records were reviewed retrospectively. Among them, 616 cases were able to follow-up by altered methods (repeated Pap smear only vs. histologic examination) and their efficacy for detecting more significant lesion (high grade squamous intraepithelial lesion: HSIL or invasive cancer) were also compared. The results were as follows; 1. The frequency of LSIL on Pap smears was approximately 0.25%. 2. The mean age was 39 years (range 18 ∼70 years). 3. Most of the gross finding of the cervix were normal or mild erosion. 4. Most of symptom was asymptomatic, or nonspecific. 5. Eighty-seven women with LSIL on initial Pap smears, have performed repeated Pap smears. 74 (85.1%) was normal, 7 (8.0%) was ASCUS, 6 (6.9%) was LSIL. Remained 52 women had subsequently histologic examination such as colposcopic directed biopsy or cone knife biopsy. These histologic results showed 192 (36.3%) with normal, 258 (48.8%) with LSIL, 77 (14.6%) with HSIL, 2 (0.4%) with microinvasive carcinoma. Based on the results in this study, we emphasize the importance of regular screening procedures for early detection of cervical lesions because there was no specific clinical characteristics in women with cytologic diagnosis of LSIL. In addition, we recommened colpo-scopic directed biopsy or cone knife biopsy as follow-up evaluation method in women with LSIL on initial Pap smear for detecting more significant cervical lesion.

자궁경부 미세침윤암의 진단 및 치료에 관한 고찰

김태진,심재욱,박인서,임경택,이기헌,박종택,노성훈,송하균,안현경,함경렬,강옥림,전종수 대한부인종양 콜포스코피학회 1997 Journal of Gynecologic Oncology Vol.8 No.2

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. The majority of patients were diagnosed at 4th and 5th decades of their lives(271/376, 72.1%). The main presenting symptoms were abnormal vaginal bleeding including postcoital spotting and leukorrhea, but considerable numbers of patients were asymptomatic(108/376, 28.7%). The majorities of patients had findings of erosion and inflammation in the cervix, but grossly normal appearing cervices were encountered in considerable numbers(97/376, 25.8%). Satisfactory colposcopic evaluations for abnormal findings were observed in 145 cases among 164 colposcopically examined patients. Abnormal findings such as aceto-white epitherium, erosion, mosaicism, atypiacal vessels were frequently observed. Overall diagnostic accuracy of Pap smear and colposcopically directed biopsies were 59.3% and 61.6%, respectively. Significant correlations were statistically observed between the rates of diagnostic accuracy and the depth of stromal invasion. Findings of positive lymph-vascular space invasion and confluent pattern of invasion were observed in 8.2% and 16.2% of cases, respectively. Both findings were observed more frequently in advanced depth of stromal invasion with statistical significance. The findings of positive lymph-vascular space invasion and/or confluent pattern of invasion in conized specimens with negative margin were also significantly correlated with relation to residual lesion in the hysterectomy specimens. The surgical managements were performed varying from conization to radical abdominal hysterectomy with pelvic nodes dissections. The conservative surgeries were performed in 218 cases and there were tendenciesnto perform conservative surgery in cases which correspond to SGO or JSOG criterias for microinvasive carcinoma. No positive node was observed in 1,294 pelvic lymph nodes dissected. There was no case of surgery-related death in this series. Including one case of central recurrence, 8 cases required postoperative treatment due to occult lesions. Among them, 5 cases did not correspond to JSOG criteria for microinvasive carcinoma and another 2 cases had positive cone margin. Accordingly we emphasized again the significance of the regular screening procedures for early detection of cervical lesions and liberal use of diagnostic conization in suspected microinvasive carcinoma cases to evaluate the exact pathologic characteristics. In addition, we suggest the JSOG criteria as a criteria for conservative surgery in microinvasive carcinoma based on the results in this study.