복강경 불임술의 임상적관찰 ( 제2보 )

류석권(SK Yoo),엄승호(SH Ohm),김태홍(TH Kim),윤석한(SH Yoon) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.2

저자는 1974년 5월 1일부터 1978년 7월 31일까지 국립의료원 산부인과를 방문한 불임시술 희망자중 복강경불임술을 시행하였던 총 900례(전기 소작법 680례 Ring법 220례)에 대한 조사 분석한 결과는 다음과 같다. 1. 연령분포는 31∼35세군이 전체의 42.6%로 수위이었고 차위는 36∼40세군으로 32.7%이었으며 평균연령은 34.3세, 최소연령은 21세, 최고연령은 46세이었다. 2. 자녀수는 3명이 전체의 50.8%로 가장 많았고 2명이 26.6%로 차위이었으며 평균 자녀수는 3명이었다. 3. 인공유산을 경험한 부인은 전체의 89%이었으며 경험이 한번도 없었던 경우는 11.0%에 불과하였다. 4. 개복수술의 기왕력이 있었던 경우는 전체의 10.4%이었고 충수돌기 절제술이 10.0%로 가장 많았으며 자궁부속기 절제술이 0.3%, 제왕절개술이 0.1%의 순이었으나 시술에 특별한 지장은 없었다. 5. 시술전까지의 피임방법은 경구피임약이 35.7%로 가장 많았고 condom법이 21.2%, 자궁내 장치법이 13.6%의 순이었고 무피임의 경우가 26.8%이었다. 6. 최종임신은 86.6%에서 임신중절수술을 행하였고 가장 많은 빈도를 차지하였다. 7. 최종임신결과로부터 불임시술과의 기간은 1∼3년인 경우가 전체의 43.3%로 가장 많았다. 8. 마취방법은 전체의 97.8%가 국소마취이었고 전신마취는 불과 2.2%이었다. 9. 시술시 CO2 gas 소요량은 4∼5l의 경우가 대부분이었으며 전체의 74.7%를 차지하였다. 10. 시술소요시간은 30분이내가 소작법군에서 전체의 70.6%, Ring법군에서 85.6%로 대부분을 차지하였고 Ring법에서 소요시간이 약간 짧았음을 보여 주었다. 11. 시술후 재원시간은 대부분이 3시간 이내로 전체의 69.2%이었고 소작법군에서 66.3%, Ring법군에서 78.4%를 차지하였다. 12. 시술과 동시에 실시한 수술로 가장 많았던 수술은 임신중절수술로서 전체의 40.2%이었으며 단지 불임시술만 실시하였던 경우는 전체의 42.7%이었고 수술소요시간이나 합병증의 발생에 있어서 큰 차이는 없었다. 13. 시술중 가장 많았던 합병증은 경미한 자궁부속기 출혈로 소작법군에서 34례(5.0%), Ring법군에서 2례(0.9%)가 있었으며 소작법 시행중 장손상이 1례 있었고 자궁천공이 3례 있었다. 전체적으로 합병증은 소작법군에서 54례(7.6%), Ring법군에서 11례(5.0%)가 있었다. 14. 시술후 가장 많이 호소하였던 증상은 요통 및 복부불쾌감으로 소작법군에서 235례(34.5%), Ring법군에서 136례(62.0%)로 양군에서 큰 차이를 볼 Among 900 cases of laparoscopic tubal Sterilizations, 220 procedures of Yoon`s ring application and 680 procedures of coagulation were performed mostly under the local anesthesia for the recent 5 years from May 1974 to July 1978. Differences between Yoon`s ring and coagulation method were made in various aspects. The results obtained were as follows; 1) The mean age of the patients was 34.3 years. The youngest was 21 years and the oldest 46 years. Age group of 31 to 35 years was most common with the incidence of 42.6%. 2) The average number of living children was 3.0, which encountered in 50.8% of the total and that of two in 23.8%. 3) Induced abortion of 13 times was the largest frequency ever found. 99 cases(11.0%) did not have the history of induced abortion, whereas 8 cases(0.9%) had experienced it more than 7 times. 4) No considerable technical difficulty during the tubal sterilization was encountered with those 103 cases(10.4%) who had previous history of laparotomy such as appendectomy in 99 cases(10.0%) adnexectomy in 3 cases(0.3%) and cesarean section in one case(0.1%). 5) Contraceptive method with oral pill prior to laparoscopic tubal sterilization was 35.7% of total cases, with condom 21.2% and with I.U.D 13.6%, respectively. 214 cases(26.8%), however, had not practiced any contraceptive method. 6) The last pregnancy before this laparoscopic sterilization was terminated by induced abortion in 86.6%, whereas term pregnancy in 13.0%. 7) The interval between outcomes of the last pregnancy and sterilization was one to three years, which occupied 43.3% of total cases. 8) Laparoscopic tubal sterilization was performed under the local anesthesia in 97.8% and under the general Anesthesia in 2.2%. 9) Four to five liters of Co2 gas were consumed for pneumoperitoneum in 74.7% of all cases. 10) Hospitalization for less than 3 hours was required in 66.3% of the coagulation group and 78.4% of the rihg group. 12) The incidental induced abortion followed by sterilization was encountered in 40.2%, an

The Efficacy of Multimodality Combination Therapy of Systemic ECF (Epirubicin, Cisplatin and 5-Fluorouracil) Chemotherapy and Transcatheter Arterial Chemoembolization (TACE) for Unresectable Hepatocellular Carcinoma

Yoon,SK,Lee,CD,Chung,KW,Park,YM,Choi,SW,Bae,SH,Choi,JY,Cho,SH,Byun,BH,Yang,JM,Park,DH,Kim,BS,Sun,HS 가톨릭중앙의료원 가톨릭암센터 1998 암심포지움 Vol.- No.2

여러 가지 치료법이 적용되고 있음에도 불고하고 TNM Ⅲ기 이상의 진행성 간암(Hepatocellular carcinoma)에 대해서는 치료성적이 매우 불량하다. 최근 소개된 ECF(Epirubicin, Cisplatin, 5-FU) 전신화학요법은 췌.담도계 악성종양에 대한 치료반응율이 40% 정도로서 비교적 양호하다고 보고되었다. 본 연구자들은 진행성 간암의 치료효율을 향상시키기 위한 다각적 치료법(multimodality therapy)으로서 ECF화학요법을 근간으로 하는 새로운 병합치료방법(Alternative tratment of systemic ECFand transcather arterial EC-chemoembolization)을 시도하였으며, 그 치료결과를 보고한다.

제왕절개술에 의한 분만율의 변화 및 요인분석

윤상기(SK Yoon),박정한(JH Park) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.8

제왕절개분만율의 변화양상과 변화하는 원인을 규명하고 제왕절개술의 적응증이 타당한가를 알아 보기 위하여 1977년 1979년, 1981년 그리고 1983년도에 계명의대 동산병원에서 제왕절개분만한 산모 1908명 가운데 의무 기록지를 찾을 수 있었던 478명을 대상으로 제왕절개기왕력, 제왕절개의 적응증, 병행된 수술, 산전관리 횟수, 임신주수, 신생아 체중 등을 조사하였다 1977년에 제왕절개분만율이 10 6%이던 것이 1979년 12 8%, 1981년 14 2% 그리고 1983년에는 19 0%로 증가하였다 이가운데 1차제왕절개는 1977년에 9 1%에서 1983년에 12 9로 증가하였고 반복 제왕절개는 1977년 1 5%에서 1983년 6 1%로 증가하는 것으로 1차제왕절개한 사람의 수가 늘어나면서 이들의 다음 분만시에는 반복제왕절개를 원칙으로 하기 때문에 전체적인 제왕절개율의 증가를 가속화하는 것으로 생각된다 제왕절개분만의 적응증이 1977년에는 아두골반불균형이 32 1%, 태아절박증 17 8%, 전치태반 16 0%, 임신중독증 10 7% 그리고 이상태위가 8 9%였으나 1983년에는 이상태위로 제왕절개 분만한 수가 증가하여 그 비율이 46%나 차지하였고 반면에 아두골반 불균형으로 제왕절개 분만한 수는 별 변화가 없었으나 상대적 비율은 22 4%로 감소하였다 이것은 과거에 이상태위라도 질식분만을 유도하던 것을 최근에는 제왕절개술을 시행하는 산과적 처치양상의 변화추세에 기인된 것이며 이것이 1차제왕절개분만율을 상승시킨 주원이 이었다 1차제왕절게인 경우 1977년에는 8 9%에서 난관결찰술을 병행하였으며 이 비율에는 별 변화가 없었으나 반복제왕절개인 경우는 1977년에 36 4%에서 1983년에는 62 5%로 증가하여 영구불임술을 겸한 제왕절개술이 증가하는 것을 알 수 있었다 To examine the changing pattern of cesarean section (c-section) and its indications medical records of 1098 cesarean deliveries occurred in 1977, 1979, 1981 and 1983 were searched and 478 records of them were found Data for the history and indication of the c-section, combined surgeries, number of prenatal check-up, gestational age at c-section and birth weight were abstracted from the medical records The c-section rate was 10 6% in 1977 and it was increased to 12 8% in 1979, 14 2% in 1981 and 19 0% in 1983 The primary c-sction was increased from 9 1% in 1977 to 12 9% in 1983 while the repeated c-section was increased from 1 5% in 1977 to 6 1% in 1983 These findings suggest that increase of primary c-section rate provides a larger pool for the repeat c-section and thus accelerated the increase of overall c-section rate The indications for the primary c-section in 1977 were CPD in 32 1%, placenta previa in 16 0%, toxemia in 10 7% and abnormal presentation in 8 9% In 1983 malpresentation was the leading cause of the primary c-section and it accounted for 46% of the total primary c-section Because of the marked increase of c-section for malpresentation, the proportion of c-section for CPD was decreased to 22 4% in 1983 although the absolute number did not change significantly Such findings represent the current trend of obstertric management of the malpresention that shifted from the vaginal delivery to the c-section and it was the major factor for increase of the primary c-section rate Tubal ligation was done together with the primary c-section in 8 9% in 1977 and remained about the same in 1983 but it was increased from 36 4% in 1977 to 62 5% in 1983 in case of the repeated c-section

임신중 태아위치 변동에 관한 관찰

윤성권(SK Yoon),서영욱(YU Suh) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.4

저자들은 1985년 12월 1일부터 1986년 9월 10일까지 본 교실에서 산전 진찰을 위해서 온 환 자 241명을 대상으로 임신 21주이후에 초음파진단을 시행한 결과를 다음과 같이 요약할 수 있다. 1. 임신중 태아위치와 만삭분만시의 태위를 비교해 보면 - 임신 21-32주사이의 이상태위의 73.8%가 정상위치로 돌아갈 수 있고, 둔위일때는 77.8% 횡위일때는 50%가 각각 정상위로 돌아감을 보았다. 이 기간동안의 정상위가 비정상위로 돌 아간 것은 1.8%였다. - 임신 33-36주에서는 이상태위의 33.3%에서 정상위치로 환원했는데, 37주 이후에는 태위 의 변동이 없었다. 2. 임신중 태아위치 변동을 관찰한 바로는 임신 21-32주사이의 태아가 만기분만전에 그 위 치를 변경하였는데 두위는 22.2% 둔위는 75%, 그리고 횡위는 80%였다. 3. 두위 및 둔위의 태반위치는 자궁저가 제일 많았고 횡위는 전치태반이 제일 많았다. 4. 이상의 결과는 임신후반기의 둔위의 치료는 별다른 처치없이 관망하였도 무방하다는 치 료방침을 뒷받침해주고 있다. The author performed ultrasound scan after 21 weeks gestaion to 241 women who visited the Department of Obsterics and Gyunecology Keimyung University for antenatal check-up during the period of December.1 1985 to September 10, 1986. The results were as follows ; 1. When a fetal presentation during pregnancy was compared with a presentation at term delivery, the malpresented fetus had a 73.8% chance of changing to a normal presentation in 77.8% of breech presentations and 50% of transverse presentations respectively. A normal presentation on the other hand indicated a very low rate of changing to a malpresentation at delivery of only 1.8% The malpresented fetus with 33weeks to 36 weeks of gestational period had a 33.3% chance of chaging to a normal presentation but there was no chance of it changing to a normal presentation after 37 weeks of gestation. 2. The observation on changes in fetal presentation during pregnancy indicated that the fetus converted its presentation before term delivery during gestational age of 21 through 32 weeks in the order of cephalic presentation(22.2%) breech presentatin(75%) and transverse presentation(80%) respectively. 3. The cephalic and breech presentations indicated that highest rates of prevalence of implantation of the placenta were in the fundal region of the uterus, and that in placenta previa the highest rate was that of transverse presentation. The above results strongly support the method of treatment in which it is felt that there is no harm in just observing breech presentations in the latter half of pregnancy without administering any type of specific control

비파열성 난관임신에 대한 Methotrexate의 비수술적 치료

윤성도,김종인,임춘근,양숙경,류호충,홍원표 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.1

저자들은 계명대학교 동산의료원 산부인과에서 초음파 및 beta-hCG로 최종 확정된 비파열성 난관임신중 착상부위의 크기가 18 mm이하, 복강내 혈액량이 소량(100 cc), 난관벽이 안정되어 있고 복통과 같은 심한 증상이 없으며, 혈압 및 맥박이 안정된 비파열성 난관임신 3명에 대한 4회의 methotrexate(1mg/kg/day)와 4회의 citrovorum factor(0.1mg/kg/day) 투여하여, 아무런 부작용 및 특별한 수술적 조작없이 치유를 경험하여, 문헌고찰과 함께 보고하는 바이다. Nonsurgical management of the unruptured tubal pregnancy with methotrexate is suggessted as an alternative to surgery in the management of early unruptured tubal pregnancy. Entry criteria required that the ectopic focus be tubal pregnanpy, no greater than 18 mm in diameter by USG, no active bleeding and no abnormal fluid collection in Cul de sac. The diagnosis was established in all three cases by sonography, serum beta-subunit of human chorionic gonadotropin. Three unreptured tubal pregnancies were treated with four doses methotrexate (1.0 mg/kg/day) followed by four doses of citrovorum fator(0.1 mg/kg/day). The treatment was based upon the level of beta-hCG, size of gestational sac on follow up USG, improvement of clinical symptoms with MTX/CF given to subjects. In all three subjects, the ectopic pregnancies were resoluted without further surgical intervention. Our experience suggests that the nonsurgical conservative management of the methotrexate may become a new, effective & safe treatment modality for the unruptured tubal pregnancy.

자궁동정맥기형에서 Transarterial Embolization(TAE) 치료경험 1 례

윤성도,김종인,이원주,홍원표,류효충,전석길 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

보고에 의하면 우리나라에서는 자궁동정맥기형을 가진 환자의 embolization후 성공한 경우는 없으나, 본례에서는 성공율을 높이기 위해 양측 자궁동맥에 TAE 시행하였다. 그러나 앞으로 이의 성공율을 높이기 위해 더 많은 연구와 다양한 시도가 필요할 것으로 사료되며, 본례에서 자궁의 동정맥기형의 보존적 치료로 TAE 시행후 임상적으로나 추적초음파상으로 큰 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다. One 20 year old who had recurrent uterine bleeding for 7 months was diagnosed of AVM of uterus by ultrasonogram and antiogram. She was treated successfully by TAE for preservation of reproductive capacity and result in prompt cessation of uterine bleeding.

디지털변전소 PRP 토폴로지 기반 데이터 흐름설계 및 MTTF, 신뢰도 계산

김석곤(SK Kim),이남호(NH Lee),박유영(YY Park),송명훈(MH Song),김남대(ND Kim),이창섭(CS Lee),김성헌(SH Kim),윤석열(SY Yoon) 대한전기학회 2022 대한전기학회 학술대회 논문집 Vol.2022 No.4

자궁외임신에 관한 임상적 고찰

신승권,최호준,윤길팔,양영균,양우열,고만석 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

The study was undertaken for the clinical evaluation and statistical analysis on the 222 patients with ectopic pregnancy who had been adbitted and treated at the Mokpo St. Columban`s Hospital from Jan. 1, 1993 to Dec. 31, 1995. The results were obtained as follows. 1. Hospital incidence of ectopic pregnancy wasd 1 in 45 deliveries(222/10,078). 2. Ectopic pregnancy was found to occur most frequently in the age group, ranging from 31 to 35 years(36.9%). 3. Nullipara was 26.5% and woman who had experienced artificial abortion was 69.8%. 4. Hemoglobin value over 10.0 gm/dL was in 78.8% and below 8.9 gm/dL in 4.1%. 5. Initial systolic blood pressure rise above 100 mmHg was in 75.0%, the mean value was 104.5mmHg. 6. The clinical manifestations were appeared in 64.4% from the last menstrual peroid to the next 5~8 weeks. 7. Total amount of intraperitoneal hemorrhage between 100~1,000 ml was in 62.1%, above the 1,000 ml was in 29.3% and less than 100 ml was in 8.6%. 8. Ectopic pregnancy was implanted follopain tuve in 95.0% ovary in 4.5% and cervix in 0.5%. Among tubal pregnancies, ampulla portion was involved in 76.6%, interstitial portion in 3.1%, isthmic portion in 12.2% and fimbrial portion in 3.1%. 9. In the past history, the laparoscopic tubal ligation was in 18%, peritonitis was in 1.8%, appendectomy was in 7.2% and cesarean section was in 8.6%. 10. Culdocentesis was positive in 70.0% and urinary HCG test was positive in 90%. 11. 77.8% of total cases was treated by salpingectomy, 14.9% by salpingoophorectomy and 1.4% by hysterectomy. 12. Of 222 total cases, no death occurred.

자궁경부암 환자의 근치적자궁적출술 후 재발 양상에 대한 연구

이선경,김승보,진규섭,윤현하 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

The incidence of recurrence in early stage cervical carcinoma is 10∼20%. Approximately 15% of patients who have recurrence will survive 2 years free of disease after additional therapy. Several prognostic factors associated with an increased risk of recurrence have been determined. Few reports have dealt with the clinical nature of recurrence following radical surgery. This paper review, in a retrospective manner, radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer. The women who recurred after radical hysterectomy and pelvic lymphadenectomy during the follow-up period were 25 cases(16.8%). Our results are as follows; Histopathologic distribution are as follows: squamous cell carcinoma 15.7%, adenocarcinoma 25.0%, adenosquamous cell carcinoma 33.0%. Anatomic site of recurrence are as follows ; central pelvic recurrence are 10 cases(40.0%), lateral pelvic recurrence are 5 cases(20.0%), distant recurrence are 10 cases(40.0%). Adjuvant radiation therapy after radical hysterectomy and pelvic lymphadenectomy significantly reduced the pelvic recurrence comparing to surgery alone(42.8% vs 81.8%)( p < 0.05 ). The incidence of recurrence are higher when in advanced stages, lymph node metastasis is seen(36.8% vs 10.0%), and the primary therapeutic modality is surgery plus adjuvant radiation therapy(26.9% vs 11.4%). Tumor size( > 4 cm) is significantly related with recurrence(8.0% vs 44.4%)(p < 0.05). Mean disease free interval according to primary therapeutic modality, recurrence site, nodal status, FIGO stage are as follows ; surgery alone compared to surgery plus radiation(22.2 months vs 12.7 months), pelvic recurrence compared to distant recurrence(20 months vs 13 months), lymph node negative compared to positive (22.4 months vs 12.6 months), FIGO stage Ib, IIa, IIb(20.3 months vs 14.2 months vs 11 months). Overall cumulative survival rate are as follows; within 6 month is 80%, within 1 year is 48%, within 2 year is 20%, and 5-year survival rate is 16%. The purpose was to evaluate which factors are related with the risk of recurrence and to analyze the outcome of recurrent patients. FurthermorE a try was made to find out how surveillance program most effective in detecting recurrence.

대동맥확장증을 동반한 Marfan씨증후군 산모 1 예

이선경,김승보,김선호,진규섭,허주엽,김범수,윤대식 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.9

The Marfan syndrome is a dominantly inherited disorder of connective tissue with multiple system involvement. The cardiac complications of Marfan syndrome in pregnancy which increases the maternal mortality. We experienced one case of Marfan syndrome in pregnancy with mild aortic dilatation, so we report the case and review of literature briefly.