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자궁절제경술을 이용한 자궁내유착증의 치료 예후에 대한 임상고찰
김병원(Byong Won Kim),신성희(Sung Hee Shin),정석(Suk Jung),홍선웅(Sun Woong Hong),김대화(Dae Hwa Kim),기광수(Kwang Soo Kee),임헌정(Hun Jung Im) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10
목적: 본원 불임클리닉에 불임증을 주소로 내원한 환자중에, 자궁난관조영술상에서 비정상적인 자궁내막소견을 보인 자궁내유착증환자에게 자궁절제경술을 시행하여 이의 효과적인 치료결과와 자궁내유착증의 재발생 빈도 그리고 이의 예방법의 유용성에 대하여 고찰하였다. 연구방법: 45명의 자궁내유착증환자를 대상으로 했으며 이를 중앙부 유착, 변연부 유착, 그리고 다발성 유착으로 구분했으며, Storz사 제품의 26F Resectoscope를 사용하여 수술을 시행하였고 재유착을 예방하기 위해서 자궁내 피임장치을 삽입하거나, 소아용 폴리카테타를 삽입하였으며, 자궁내막 상피화를 증진시키기 위하여 Conjugated estrogen(Premarin) 5mg을 30-50일간 투여한후 medroxy progesterone acetate(Provera) 10mg을 10일간 투여하여 소퇴성출혈을 유발시킨후 자궁 난관촬영술을 시행하여 수술 전후의 자궁내 상태를 비교하였다. 결과: 계속적인 추적관찰이 이루어진 41명에서 자궁난관조영술상 수술전 병변이 소실된 경우가 21명, 개선된 경우가 12명, 큰 변화가 없거나 재발된 경우가 8명으로 81%의 높은 치료율을 보였다. 41명중에서 재유착의 예방을 위해서 소아용 폴리카테타를 삽입한 경우는 20명으로 이중 5명(25%) 에서 재발을 하였고, 자궁내 피임장치를 삽입한 경우는 21명으로 이중 3명(14%)에서 재발을 하였다. 추적관찰환자중 15명에서 임신이 되었고 이중 10명은 만삭분만을 하였고 3명이 초기 자연유산이 되었으며 1명은 자궁외임신으로 복강경하 난관절제술을 시행했으며 1명은 임신이 진행중이다. 결론: 이상의 결과를 볼때 자궁내유착증의 치료에 자궁절제경술이 유용한 방법으로 사료되며, 수술 후 자궁내 재유착의 예방을 위해서 자궁내 피임장치를 삽입한 경우가 소아용 폴리카테타를 삽입한 경우에 비하여 재유착의 발생율이 비교적 낮은 경향을 보임을 알 수 있었으나, 향후 더욱 많은 예에 대한 연구와 면밀한 추적관찰이 필요하리라 생각된다. Objectives: From February 1995 to April 1998, those patients who had visited for evaluation of infertility, shown abnormal endometrial pattern on hysterosalpingography underwent resectoscopic operation. We evaluated about its therapeutic effect, recurrence rate of uterine adhesion and effectiveness of its assisted method. Method: We have reviewed 45 cases of intrauterine adhesion, classified as a central type, marginal type and multiple type. We used 26F resectoscope made in Storz for operation and inserted Lippes loop or pediatric foley catheter for prevention of readhesion. For promoting reepithelialization, conjugated estrogens(premarin) 5mg daily for 30 - 50 days were given and then 10mg of medroxyprogesterone acetate(provera) were added daily for the last 10 days. We evaluated the uterine cavity condition preoperatively and postoperatively by using hysterosalpingography. Result: In 45 cases, 41 cases were followed up postoperatively. 21 cases were markedly improved, 12 cases were improved and 8 cases were not improved or recurred on hysterosalpingography. In 41 cases, for prevention of readhesion 20 cases were used pediatric foley catheter and 5 cases(25%) were recurred. 21 cases were used Lippes loop and 3 cases(14%) were recurred. Pregnancy outcome was as follows;15 cases were pregnant and 10 cases delivered a viable infant, 3 cases aborted spontaneously, 1 case was ectopic pregnancy and laparoscopic salpingectomy was done, 1 case was ongoing pregnancy. Conclusion: This report suggests that resectoscopic operation is very effective in the treatment of intrauterine adhesion(therapeutic rate of 81%) and that the use of Lippes loop seems like to have the less recurrence rate than the use of pediatric foley catheter in prevention of postoperative readhesion, but more experience and further follow-up are necessary to obtain more detailed conclusions.
김형호,김병선 ( Byoung Sun Kim ),배유영 ( Yu Yung Bae ),선진규 ( Jin Gyu Sun ),기광수 ( Kwang Soo Kee ),임헌정 ( Hun Jung Im ),이주엽 ( Ju Yub Lee ) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7
Retroperitoneal Schwannama is relatively rare and benign tumor originating from Schwann cell. Schwannomas arising in the retroperitoneum are infrequently reported. The majority of Schwannoma is found incidentally and misdiagnosed for other benign conditions both clinically and radiologically. We report a case of a benign retroperitoneal pelvic Schwannoma which was preoperatively misdiagnosed as an ovarian tumor with brief review of literatures.
이상녕(Sang Nyeoung Lee),강창구(Chang Gu Kang),이주엽(Ju Yub Lee),정금지(Kum Ji Jung),강용필(Yong Pil Kang),기광수(Kwang Soo Kee),임헌정(Hun Jung Im) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11
Pseudomyxoma peritonei is a clinical entity in which the peritoneal surface and omentum are involved with gelatinous, mucinous implants, and often massive gelatinous ascites. Most cases originate from ruptured ovarian mucinous cysts or appendiceal mucoceles, and involve only the intraperitoneal cavity. But there is much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the mucinous cystic tumor of borderline malignancy in unilateral ovary with rupture. A case of pseudomyxoma peritonei is reported with a brief review of the literature.
전 자궁 적출술 및 양측 부속기 절제술 후 발생한 난소 잔유물 증후군
신성희(Sung Hee Shin),이주엽(Ju Yub Lee),홍선웅(Sun Woong Hong),정금지(Kum Ji Jung),김병선(Byoung Sun Kim),강용필(Yong Pil Kang),기광수(Kwang Soo Kee),임헌정(Hun Jung Im) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6
Ovarian remnant syndrome is a rare condition which develops when functional ovarian tissue is left in situ after intended bilateral oophorectomy. It produces clinically significant syndrome, namely chronic pelvic pain and dysmenorrhea. Although the true incidence of this syndrome is unknown, an apprant increase in incidence has been reported. We have experienced a case of ovarian remnant syndrome showing chronic pelvic pain and palpable abdominal mass after difficult gynecologic operation. So, we report this case with a brief review of literatures.
이장용(Jang Yong Lee),홍선웅(Sun Woong Hong),박애별(Ae Byul Park),강용필(Yong Pil Kang),기광수(Kwang Soo Kee),임헌정(Hun Jung Im),김경수(Kyung Soo Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8
Actinomycosis is a rare disease in human and has variable clinical features, which make the diagnosis difficult. Actinomycosis may be confused with malignancy and other inflammatory diseases because of its infiltrative nature and its tendency to invade normal anatomic barriers. We have experienced a case of abdominal actinomycosis combined with ovarian mucinous cystadenocarcinoma and report this case with brief review of literatures.
강기철(Gi Chul Kang),이장용(Jang Yong Lee),배유영(Yu Young Bae),김대화(Dae Hwa Kim),기광수(Kwang Soo Kee),임헌정(Hun Jung Im) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9
Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has increased after wider use of assisted reproductive technology. The rising incidence presents a serious problem as the diagnosis of this potentially fatal condition is often missed. Careful pelvic examination combined with serial β-hCG determinations, and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in vitro fertilization and embryo transfer(IVF-ET) with a brief review of literature.
김경수,강창구,정석,배유영,박애별,선진규,기광수,임헌정 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5
난소의 과립막 세포종은 비교적 드문 여성화 종양이다. 통증이 없이 서서히 커지는 특성이 있어 진단시 종양의 크기가 매우 클수 있으며 난소에 국한되는 경우가 많다. 일차적 치료는 수술이나 재발이 잦으며, 이때 시행하는 재수술, 화학요법, 방사선요법 또는 병합요법의 결과는 보고마다 다양하다. 저자들은 단기간에 걸쳐 빠르게 커져 복부전체를 차지하는 거대한 난소 과립막 세포종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Ovarian granulosa cell tumor is a uncommon low-grade feminizing malignancy. Its natural history shows slow growth without pain. It often reveals to be very large sized mass when diagnosed, and is confined to the involved ovary in many cases. Complete surgical removal is primary treatment and recurrences thereafter are relatively common. Postoperative adjuvant therapy including reoperation, chemotherapy, radiation therapy or a combination therapy has been used with various degrees of success. We experienced a case of huge ovarian granulosa cell tumor occupying whole abdominal cavity by rapid growth, which is presented with a brief review of corresponding literatures.