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GG-22 : Predictive value of Tubo-ovarian abscess In Pelvic Inflammatory Disease
이석우,이성종,김장흡,유시현,윤주희 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
It is well known that tubo-ovarian abscess(TOA) is end stage disease of pelvic inflammatory disease(PID) and associated with high risk mortality and prompt surgical intervention occasionally. The purpose of this study was to clarify the predictive value of TOA by comparing the clinical and laboratory data between PID both with and without TOA. The charts review of 499 women who admitted with clinically and surgically, imaging-based diagnosed PID between 2001 and 2011. We divided them into two groups (PID with and without TOA). The groups were compared with respect to patient characteristics, clinical, and laboratory findings including inflammatory markers such as white blood cell(WBC) count, erythrocyte sedimentation rate(ESR), C-reactive protein( CRP), and CA 125. Sixty nine and 400 women were in the TOA and non-TOA group. The mean age, rate of intrauterine device(IUD) insertion, inflammatory markers including WBC count, ESR and CRP, and CA 125 levels were higher in the TOA group than the non-TOA group. The independent factors to predict TOA were increased age, IUD insertion, increased CRP and CA 125, and chlamydial infection. The highest diagnostic value of TOA was in order of CA 125, ESR, CRP, and WBC. The area under the receiving operating curve of CA 125, ESR, CRP, and WBC was 0.82, 0.76, 0.73 and 0.63, respectively. TOA may increase medical cost for surgical and medical treatment as well as reproductive complication. Further study will be needed to clarify the specific markers for TOA and these will be expected to reduce the occurrence of TOA.
이석우,이성종,김장흡,유시현,윤주희 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Background: The first steps in the diagnosis of an ectopic pregnancy are to use a sensitive qualitative urine test to detect the β-hCG and to perform a transvaginal ultrasonography. A negative urine pregnancy test result is generally used to exclude an ectopic pregnancy. We reproted uncommon case of an secondary omental implanation after opeartion of Lt tubal pregnancy with with negative urine hCG test. Case: A 27-year-old woman presented to the ER with severe abdominal pain. The qualitative urine pregnancy test was negative. Pelvic CT revealed a massive hemoperitoneum with active bleeding in the left adnexal area. The laparoscopic findings showed the ruptured ampullary segment of left fallopian tube with active bleeding. Histopathologic sections from the left tube revealed a few trophoblastic cells. The β-hCG titers decreased from 501 mIU/mL to 157 mIU/mL. She had no symptoms of abdominal pain. After 2 weeks, she revisited to the ER with severe abdominal pain. Vaginal ultrasonography showed a large amount of free fluid in the Pouch of Douglas. Laparoscopy revealed 1,500mL of blood in the pelvic cavity and omental implantation with 2 cm in diameter and active bleeding. Partial omentectomy was done. The pathology revealed evidence of granulomas by suspicious degenerative feto-placental tissue remnants. Conclusion: For patients diagnosed with tubal or ovarian pregnancy who have negative urine pregnancy test results and decreased levels of serum β-hCG,, late-onset omental implantation should be considered as a possibility.
Comparison of Laparoscopic and Laparotomic Surgery for the Treatment of Peritoneal Inclusion Cyst
이석우,송민종,이성종,윤주희 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC. Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups. There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (p=0.037, p=0.047 and p=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209). Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.