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한국인 골반내 장기 탈출 환자에서 실리콘 환 페사리의 이용
김진홍 ( J. H. Kim ),이유미 ( Y. M. Lee ),김은중 ( E. J. Kim ),정기욱 ( K. W. Chung ),권동진 ( D. J. Kwon ),유영옥 ( Y. O. Lew ),김도강 ( D. K. Kim ),김수평 ( S. P. Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12
Pessaries have been used for centuries in the management of pelvic organ prolapse. Although surgical repair has been popularized by surgeons and gynecologists for younger women with pelvic relaxation, pessaries remain a useful palliative strategy for patients who refuse surgery as represent higher operative risks. Methods: Due to the recent advancement of material science, medical-grade silicone has replaced the traditional rubber, plastic, or Lucite, since it is more durable and non-allergenic. The authors used silicone ring pessaries in 98 Korean women with pelvic organ prolapse compromising those who are at high risks for anesthesia because of medical disease, who want to conceive in the further or those who wish to avoid surgical therapy. Results: 1. The average age of patients is 62.69±11.37 years. Period of pelvic organ prolapse is 78.64±56.23 months and duration of pessary insertion is 17.34±11.75 months. 2. The average time point of first complication was 7.91±4.25 months. The time point of complication of user group and non-user group of estrogen and lubricant was 10.06±3.31 months and 4.13±3.27 months, respecitively, which shows that complication occurred later in user group than in non-user group. 3. Pessary with support(16 out of 43 patients, 37.2 %) shows more serious complications (ulceration of vaginal wall) than pessary without support(1 out of 37 patients, 2.7 %). 4. The pessary sizes that fit best the prolapsed uteri of Korean women are #3(diameter of 63.5 mm) and #4(diameter of 69.8 mm) (60 out of 77, 77.9 %). Natural correction rate after removal of pessary(pessary insertion period: over 1 year) was 22.7 %(10 out of 44). 5. The most common complication in patient with uterine prolapse with or without cystocele is erosion. On the other hand ulceration of vaginal wall is the most common complication in those with rectocele and cystocele. 6. Among patients with pelvic organ prolapse in Korea, when there was uterine prolapse only, #3 and #4 pessary without support was the most commonly used(22 of 35, 62.9 %). When uterine prolapse was accompanied with rectocele or cystocele, #3 and #4 pessary with support fitted the best (accompanied with cystocele only: 14 of 26, 53.8 %, accompanied with cystocele and rectocele: 8 fo 9, 88.9 %). Conclusion: The above results suggest that we could recommend more utilization of proper shaped and sized pessary of patients with pelvic organ prolapse along with regular follow-up examination and proper use of estrogen, Trimosan, antibiotics, and anti-inflammatory drugs, in place of surgical therapy as the population of old aged women increases. Furthermore, education of the old aged women who are reluctant to visit Dr`s office how to do self-fitting the pessary will result in time saving and reduction of medical costs.
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한상하(S. H. Han),이희중(H. J. Lee),조형권(H. G. Cho),김재선(J. S. Kim),장병우(B. W. Jang),변태섭(T. S. Byeun),신진웅(J. W. Shin),노덕영(D. Y. Ro),신종철(J. C. Shin),김도강(D. K. Kim),김수평(S. P. Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11
Objective: The purpose of this study was to evaluate the course of Systemic Lupus Erythematosus through hematologic change during pregnancy and the outcome of pregnancy in patients with SLE. Method: This retrospective study was done by the review of medical records of 25 pregnancies complicated with SLE in patients betwen Jan, 1989 and Dec, 1997. Results: The common laboratory hematologic change in SLE with pregnant woman was elevated WBC count during peripartum period(P<0.05), significantly decreased during postpartum(P<0.05). And, during peripartum period ESR change was significantly elevated (P<0.05) but not obtained data during postpartum period. The serum level of C3 complement and C4 complement were not significantlty changed during peripartum and postpartum. So these factors are not affected by gestational condition. SLE pregnant woman's kidney function was relatively maintained during peripartum and postpartum according to BUN/Cr levels. Among 25 cases of SLE pregnant woman, there was 1 case of midtrimester termination due to spontaneous premature rupture of membranes (4 %), 5 cases of preterm birth (20 %), other were term delivery was done (19 cases, 76 %). Conclusion: Our data suggest that the risk of pregnancy with SLE is not harmful to pregnant woman, especially hematologic indicies and not to bad in pregnant outcome of newborn baby in our cases.
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