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6 cm 이상의 난소 유피낭종절제술에 있어서 골반경수술법과 개복수술의 비교 고찰
오성택,이지영,김은미 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1
Traditionally laparotomic cystectomy has been performed for large ovarian dermoid cyst, because the spillage of content was inevitable and the complete removal of spilled material in pelvic cavity was difficult. Therefore the method of pelviscopic cystectomy was modified to minimize the spillage of content for dermoid cyst over 6 cm in our hospital. The purpose of this study is to evaluate the efficacy of this pelviscopic cystectomy compared with traditional laparotomic cystectomy. Dermoid cysts over 6 cm were diagnosed by ultrasonography, MRI, CT and diagnostic laparoscopy. The duration of operation, postoperative recovery time and duration of hospital stays in 45 patients treated by modified pelviscopic cystectomy were compared with those in 27 patients treated by laparotomic cystectomy. The mean duration of operations was 1.37 ± 0.7 hours in laparotomy and 1.59 ± 0.4 hours in pelviscopy, so any significant difference was not found between these two groups. Postoperative complication due to spillage of content was not noticed in either laparotomy or pelviscopy. Recovery of gastrointestinal peristalsis was observed at postoperative 1.9 ± 0.8 days in laparotomy and 1.0 ± 0.5 days in pelviscopy. Therefore peristalsis of gastrointestinal tract was more rapidly recovered in pelviscopy than in laparotomy(p<0.01). Dis-appearance of major postoperative pain was observed on 2.7 ± 0.8 days after operation in laparotomy and 1.3 ± 0.4 days in pelviscopy, so postoperative pain was disappeared more rapidly in pelviscopy(p<0.01). The mean duration of hospital stay was 4.2 ± 0.4 days in pelviscopy, and it was significantly shorter than 5.5 ± 0.7 days in laparotomy(p<0.01). Therefore it was suggested that pelviscopic cystectomy, if it is modified to minimize peritoneal spillage of contents, was better than laparotomy even in dermoid cyst over 6 cm.
변지수,송태복,김윤하,이지영,김은미 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.7
제왕절개 수술이 비교적 젊고 건강한 여성에서 시행되어지고 개복수술이지만 장관의 조작은 거의 하지 않는다는 점에 착안하여 제왕절개 수술한 여성에서 수술 후 조기에 경구 영양공급을 하는 것이 고식적인 방법으로 채택되어져 온 장음이 들리고 가스가 배출된 후에 식사를 공급하는 것과 비교하여 위장관 기능에 이상 증상을 초래하는 빈도를 조사함으로써, 조기 경구 영양공급의 임상적인 유용성에 대해 알아보고자 1997년 5월 1일부터 동년 8월 31일까지 전남대학교병원 산부인과에서 제왕절개분만한 80명의 환자를 대상으로 다음과 같은 결과를 얻었다. 1. 주사 수액제제의 투여 기간은 조기 경구 영양공급 군(연구군)에서 21.6±7.8시간으로 대조군의 32.2±9.0시 간보다 더 짧았고(p<0.01), 따라서 주사 수액제제의 투여량도 연구군에서 3.4±1.3 L로 대조군의 4.6±1.0 L보 다 의의있게 적은 양이었다(p<0.01). 2. 수술 종료 후 일상적인 식사가 가능하게 되는데 걸 리는 시간은 연구군에서 17.4±4.1시간으로 대조군의 37.6±11.4시간보다 더 짧았다(p<0.01). 3. 수술 후 처음으로 가스가 배출되는데 걸리는 시간 은 연구군에서 29.6±8.0시간으로 대조군의 33.6±8.6시 간보다 더 짧았다(p<0.05). 4. 위장관의 이상 증상으로 환자가 호소하는 복부팽만 이나, 오심, 구토 증상이 나타나는 빈도는 연구군에서 17.5 %이고 대조군에서 15.0%로 의의있는 차이가 아니었다. 이상의 결과로 제왕절개 수술 후 조기에 경구 영양 공급을 하는 것이 고식적인 방법과 비교하였을 때 위장 관계 이상 증상의 빈도를 증가시키지 않으면서, 더 빨리 일상식사가 가능하게 됨을 보았으며 이런 결과로 보아 조기에 경구 영양을 하는 것이 빠른 퇴원도 용이하게 할 수 있을 것으로 사료되었다. This study was performed to assess the gastrointestinal function and patient acceptability of early oral feeding after cesarean delivery. From May 1997 to August 1997, eighty healthy women delivered by cesarean section were assigned alternately to either early initiation of oral feeding or conservative dietary management. In the early feeding group, the first postoperative oral feeding of regular hospital diet was provided within 8 hours after completetion of operation. In the conservative management group, the regular hospital diet was given only if the abdomen was not distended, bowel sounds were auscultated, and flatus had passed. The patient information and data on 1) the duration and amount of intravenous fluid administration, 2) the time of return to regular diet and first gas passage and 3) the rate of gastrointestinal complaints such as nausea, vomiting, or abdominal distension were recorded prospectively. The results were as follows; 1. The duration of intravenous fluid administration in the early feeding group (study group) was significantly shorter than those in the control group, 21.6±7.8 versus 32.2±9.0 hours (p<0.01). Therefore, the amount of iv fluid in the study group was significantly smaller than those in the control group, 3.4±1.3 versus 4.6±1.0 L (p<0.01). 2. Compared with the control group, the study group had a rapider return time to regular oral diet, 17.4±4.1 versus 37.6±11.4 hours (p<0.01). 3. Compared with the control group, the study group had a significantly shorter mean interval to first gas passage, 29.6±8.0 versus 33.6±8.6 hours (p<0.05). 4. The frequency gastrointestinal complaints such as nausea, vomiting, or abdominal distension did not show significant difference in both groups; 17.5% in the study group versus 15.0% in the control group.