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제왕절개 수술 반흔 부위에 착상한 자궁벽내 임신의 Methotrexate 치료
홍진화 ( Jin Hwa Hong ),정유아 ( Yu A Jeong ),황종하 ( Jong Ha Hwang ),김재원 ( Jae Won Kim ),이경주 ( Kyung Ju Lee ),김철환 ( Chul Hwan Kim ),서호석 ( Ho Suk Saw ),박용균 ( Yong Kyun Park ),조수용 ( Soo Yong Chough ),허준용 ( Jun 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9
Intramural pregnancy implanting in the previous cesarean section scar is one of the rarest form of an ectopic pregnancy and probably the most dangerous form because of its risk of rupture and humorrhage. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contract of endometrium. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are highly desirable. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, treated completely with systemic methotrexate injection. So, we report this case with a brief review of the literature.
홍진화 ( Hong Jin Hwa ),송승훈 ( Song Seung Hun ),이재관 ( Lee Jae Gwan ),오민정 ( O Min Jeong ),서호석 ( Seo Ho Seog ),박용균 ( Park Yong Gyun ),허준용 ( Heo Jun Yong ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.3
목적 : 증상을 동반하는 자궁 근종의 치료로서 자궁 동맥 색전술의 치료 효과에 대해 알아보고자 한다. 연구 방법 : 2000년 1월부터 2002년 3월까지 자궁 근종으로 진단 받은 40명의 환자들을 대상으로 본 시술을 시행하였다. 시술 후 1개월, 2개월, 3개월, 6개월, 12개월마다 외래 추적 검사를 실시하였다. 추적 검사 기간 중에 자궁 근종의 용적, 혈청 헤모글로빈 수치, 월경 지수 등을 측정하였다. 결과 : 환자들의 주 증상은 월경 과다(85%), 월경통 (35%), 골반통 (10%)이었고, 대부분의 환자들은 시술 3개월 후에 증상의 호전을 보고하였다. 또한 혈청 헤모글로빈의 수치와 생리 지수의 변화는 환자의 증상의 호전과 유의한 상관관계를 나타내었다. 그리고 자궁 근종의 용적도 1개월 후 40%, 3개월 후 56%, 6개월 후 71%, 12개월 후 72%의 감소를 보였다. 결론 : 자궁 근종의 치료 방법으로서 자궁 동맥 색전술은 최소 침습적이면서도 효과적인 치료법이라고 생각된다. Objective : To evaluate the role of uterine artery embolization as treatment for symptomatic uterine leiomyoma. Methods : From January 2000 to March 2002, 40 consecutive patients (mean age, 42.5 years; range, 27-53 years) underwent uterine artery embolization for the treatment of uterine leiomyomas. After a nonselective pelvic arteriogram was obtained, bilateral embolization was performed in each case. After discharge from the hospital, the patients were followed up at regular intervals (at 1st, 2nd, 3rd months, at 6th months, at 12 months and annually thereafter). The mean duration of follow-up was 11.5 months (range; 2-30 months). During the follow-up period, consecutive myoma volume, serum hemoglobin, menstrual index (MI) were checked. All patients were contacted by telephone to confirm any change in their symptoms after the embolization and were questioned regarding their satisfaction with the procedure. Results : A total of 40 patients were treated successfully. Initially, the presenting symptoms of the participants were menorrhagia (34.40, 85%), dysmenorrhea (14/40, 35%) and bulk symptoms (4/40, 10%). Most patients had improvement in symptoms by 3 months after the procedure and patient satisfaction paralleled the symptom change. Of 34 patients who initially presented menorrhagia, 28 patients checked their own serum hemoglobin levels and recorded MI regularly. The patterns of change of serum hemoglobin levels and MI during follow-up period were statistically correlated with their symptom changes. And the mean dominant myoma volume was reduced by 40% after 1 month, by 56% after 3 months, by 71% after 6 months and by 72% after 12 months (ANOVA, SAS 8.0, p<.0007). Conclusion : We conclude that uterine artery embolization for leiomyoma is minimally invasive and effective method of treatment. Most patients report improved symptoms and satisfaction with the outcome from treatment.
정유아 ( Yu A Jeong ),홍진화 ( Jin Hwa Hong ),황종하 ( Jong Ha Hwang ),송승훈 ( Seung Hun Song ),이경주 ( Kyeong Ju Lee ),오민정 ( Jun Young Hur ),허준용 ( Min Jeong Oh ),박용균 ( Yong Kyun Park ),조수용 ( Soo Yong Chough ),김철환 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.2
The definition and management of microinvasive cervical cancer varies from time to time depending on the organization involved and is a persistent focus of controversy. The purpose of defining microinvasion is to identify a group of patients who are not a
( Ji Yeon Hyun ),( Kyung-jin Min ),( Sun Young Yang ),( Jae-kwan Lee ),홍진화 ( Jin Hwa Hong ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective To determine whether triage for atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) from the updated American Society for Colposcopy and Cervical Pathology cervical cancer screening guidelines is applicable in Korean women. Methods We investigated women with ASC-US or LSIL including referred from local hospitals visited for cervical cancer screening at Korea University Guro Hospital from February 2004 to December 2014. Detailed information on the results of Papanicolaou (Pap) smears, human papillomavirus (HPV) DNA tests, and cervical biopsies were collected through chart review. Cervical biopsy results were compared in eligible women according to individual Pap smear findings and HPV DNA status. Results Of 216,723 possible cases, 3,196 were included. There were 212 (6.6%) women with ASC-US and 500 (15.6%) with LSIL. The risk of ≥cervical intraepithelial neoplasia (CIN) 2 was significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (93.3% vs. 6.7% and 96.7% vs. 3.3%, P<0.001 and P<0.001, respectively). The risk of ≥CIN 3 was also significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (97.0% vs. 3.0% and 93.0% vs. 7.0%, P<0.001 and P<0.001, respectively). Age-stratified analysis revealed that more CIN 2 or CIN 3 was diagnosed in women aged 30 to 70 with ASC-US or LSIL when HPV DNA was present. Conclusion Observation with Pap and HPV DNA tests rather than immediate colposcopy is a reasonable strategy for ASC-US or LSIL when the HPV DNA test is negative, especially in women aged 30 to 70. Reflection of these results should be considered in future Korean screening guidelines.
부인과 수술 합병증으로 발생한 비뇨기계손상에 대한 복강경수술의 임상적 효용성
엄정민 ( Jeong Min Eom ),김지연 ( Jung Hun Lee ),김재연 ( Jee Yeon Kim ),홍진화 ( Jin Hwa Hong ),이교원 ( Kyo Won Lee ),최중섭 ( Joong Sub Choi ),주관중 ( Kwan Joong Joo ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.4
목적: 부인과 수술 합병증으로 발생한 비뇨기계 손상에 대한 산부인과 의사에 의한 복원술에 있어 복강경 수술의 가능성과 유용성을 보고자 하였다. 연구방법: 2003년 3월부터 2010년 2월까지 성균관대학교 의과대학 강북삼성병원 산부인과학교실에서 부인과 수술 합병증으로 발생한 비뇨기계 손상에 대한 복강경 수술을 받은 총 38명의 환자들의 의무기록을 후향적으로 분석하였다. 비뇨기계 질환으로 복강경 수술을 받은 환자들의 연령, 분만력, 체질량지수(body mass index), 복부 수술력, 비뇨기계 손상의 종류, 시행된 복원 술기, 복원술 후 임상경과를 분석하였다. 결과: 총 38예의 비뇨기계 손상 중, 27예가 방광손상이었고, 6예가 요관질누공 1예를 포함한 요관손상이었으며, 5예가 방광-질누공이었다. 환자 나이의 중앙값은 45세(범위, 31-77세), 분만 횟수의 중앙값은 2회(범위, 0-4회), 체질량지수 중앙값은 21.4 kg/m2 (범위, 18.8-31.4 kg/m2), 이전 복부수술 횟수 중앙값은 1회(범위, 0-3회)이었다. 추적관찰 기간은 39개월(범위, 16-78개월)이었다. 모든 환자에서 개복술로의 전환 없이 복강경을 통해 성공적인 복원술이 시행되었다. 복원술 이후 추적관찰 기간 동안 합병증은 발생하지 않았다. 결론: 부인과 수술과 관련된 비뇨기계 손상에 대하여 숙련된 부인과 수술팀의 복강경을 이용한 복원술로 성공적인 수술적 처치가 가능하다. Objective: To assess efficacy and feasibility of laparoscopic surgery for genitourinary tract injuries related with gynecological surgery. Methods: We conducted a retrospective study of 38 patients undergoing laparoscopic surgery to treat genitourinary tract injury which occurred during gynecologic surgery in Kangbuk Samsung Hospital from March 2003 to February 2010. We analyzed the demographic and clinical characteristics including history of previous abdominal surgery, the type of injury, type of repair procedure, and any complications. Results: Of the 38 patients, 27 had urinary bladder injury, six had ureter injury including ureterovaginal fistula in one, and five had vesicovaginal fistula. The median age of patients, the median body mass index, and the median follow-up period were 45 years (31 to 71 years), 21.4 kg/m2 (18.8 to 31.4 kg/m2), and 39 months (16 to 78 months), respectively. There were no laparoconversions. No intraoperative or postoperative complications occurred. All patients have been asymptomatic, and their follow-up intravenous pyelograms and ultrasound examinations have been normal. Conclusion: Laparoscopic repair of genitourinary tract injuries occurred during gynecologic surgery is feasible for experienced laparoscopic surgical team in gynecology.