한국형 자궁경부 촬영진 ( New Cervicography ) , 세포검사 그리고 HPV-DNA 검사를 이용한 새로운 자궁경부암 검진 모델 ( Model ) 개발

김승조(SJ Kim),박찬규(CK Park),이효표(HP Lee),남궁성은(SE Namkoong),강순범(SB Kang),서호석(HS Saw),이재관(JK Lee),김수녕(SN Kim),김재원(JW Kim),배석년(SN Bae),김찬주(CJ Kim),이근호(KH Lee),이선영(SY Lee),김인호(IH Kim),이찬(C Lee),이정노(JN Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

N/A Objective : The false negative rate of conventional cytology is reported to range from 18 to 45%. It is necessary to develop more effective screening strategies that would ideally be more accurate than conventional cytology. This study is designed to investigate the potential of conventional cytology, cervicography, HPV-DNA testing and their combinations as primary screening techniques for cervical neoplasia. The purpose of this project is to develop the models and guidelines for screening tools of cervical cancer of the uterus by evaluating sensitivity, specificity and cost-effectiveness of all the screening methods. Study design : We conducted a screening of random sample of women who visited the department of OB-Gyn. of five different major university hospitals such as Catholic University Hospital, Korea University Hospital, Seoul National University Hospital, Yeonsei University Hospital and Pochon CHA University Bundang CHA Hospital, from May 1, 1996 to April 30, 1999. In a cohort women with an age range of 20 to 70 who underwent routine cytologic screening at Catholic University, Hospital Bundang CHA General Hospital and local clinics from April 1, 1996 to Decomber 31, 2000. cervicography (n=417,125) and testing for HPV-DNA (n=1,347) by the hybrid capture assay were studied for the ability of the cervical cancer screeuing. A new cervicography system with Kim's classification which was developed by Prof. Kim Seung Jo as an adjunctive method for the cervical cancer screening was applied in this cohort study. And then, accuracy, effectivencess, cost-effectiveness of the single or combined screening method were analysed. Result : Sensitivity and specificity of Pap smear were ranged from 55.6% to 83.1% and 72.8% to 88.3% respectively. The combination of Pap smear and cervicography had sensitivity from 89.7% to 98.6%, specificity from 68.2% to 93.2%. With combination of Pap smear, HPV DNA test and cervicography, sensitivity became also highest accuracy among all screening methods from 92.8% to 98.8%. Considering medical charges for diagnosis and social cost occurred by false positive and false negative results, the most cost-effective diagnostic modality was thought to be the combination of Pap smear and cervicography(91,433 won). In patients who were diagnosed as LSIL, colposcopic examination confirmed progression to high grade intraepithelial lesion(HSIL) in 10.7% patients, persistence of LSIL in 55% patients during the 3 year follow-up period. Accuracy of the screening for cervical cancer and CIN can significantly be improved by cytology with new cervicography rather than cytology alone. We concluded that cervicography can be important adjunctive tests for cervical cytology, improving the effectiveness of cervical screening by allowing a more sensitive detection of cervical neoplasia.

만성자궁경부염치료에 있어서 저온응고법의 임상적 효과

김영태(YT Kim),박찬규(CK Park),최동희(DH Choi),김재욱(JU Kim),김수녕(SN Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.12

만성자극경부염에 대한 저온응고법의 치료효과를 알아보가자 1985년 11월부터 1987년 12월 까지 연세대학교 의과대학 산부인과학교실에 내원한 외래환자중 질확대경조준하생검상 만성 자궁경부염이 확진되어 저온응고법을 시행했던 211명의 환자를 대상으로 치료전후 병변의 정도변화, 임상증상의 변화, 그리고 치료후 합병증을 조사, 분석하여 다음과 같은 결론은 얻 었다. 1. 만성자궁경부염 환자의 연령은 23세에서 64세까지 분포하였으며 30-39세의 연령군이 48.3%로 가장 높앗고, 평균연령은 37.9세이었다 2. 환자의 5.2%는 미경산부엿고 94.8%가 1회이상의 분만력을 가지고 있엇으며 이중 4회이상 의 출산력을 가진 환자는 10.9%이었다. 3. 만성자궁경부염 환자에서 치료전에는 경증, 중등도, 중증의 자궁경부미란이 각각 16.6%, 51.4%, 32.0%였으며 치료율은 각각 100%, 98.6%, 90.6%로 평균 96.3%였다. 4. 치료전의 주요 임상증상인 백대하, 질출혈, 성교후 출혈, 성교통, 월경통이 각각 91.9%, 32.7%, 19.4%, 16.5%, 10.2%이었으나 치료후에는 각각 3.1%, 1.9%, 0.6%, 1.3%, 1.3%로 감소 하였다. 5. 저온응고법 시술에 따른 합병증으로는 골반통, 질출혈, 하복부 불쾌감이 있었으며 각각 7.2%, 10.9%, 18.1%였다. 이상의 결과를 종합하여 볼대 저온응고법은 백대하, 질출혈, 성교후 출혈 등의 임상증상과 자궁경부미란을 보이는 만성자궁경부염에 효과적인 치료방법이라고 사료된다. 1. The age distribution of the patients with chronic cervicitis showed ; twenties 13.2%, thirties 48.3% fourties 30.3% fifties 7.1% and sixties 1.1%. 2. The parity of the patients ; nulliparity 5.2% primiparity 11.8% and multiparity 72%. 3. The size of cervical erosion at the time of diagnosis were mild(16.6%) moderate (51.4%) and severe (32.0%) respectively while the cure rate within 8 weeks after cold coagulation was 96.3%. 4. Main clinical symptoms at the time of diagnosis were leukorrhea(91.9%) intermenstrual bleeding (32.7%) postcoital bleeding (19.4%) dyspareunia(16.5%) and dysmenorrhea (10.2%) in that order. After cold cagulation these symptoms were reduced to 3.1% , 1.9% , 0.6%, 1.3% and 1.3% respectively. 5. complications after cold coagulation were abdominal discomfort (18.1%) vaginal bleeding (10.9%) and pelvic pain (7.2%) in that order.

근치적 자궁절제술 후 Hemovac 배액술의 효과 및 말단부 세균 배양의 효용성

김수녕,이정필,김진영,박찬규,권혜경,정재은,강성은 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

골반임파절 절제술 및 대동맥방임파절 절제술을 포함한 부인암 수술의 주요 합병증으로는 누공, 임파낭종, 골반강내 혈종, 창상감염 및 발열로 인한 사망들을 들 수 있으며 이를 감소시키기 위해 도관을 이용한 배액술, 적절한 항생제의 투여, 수혈, 수술기법 및 마취기술의 개발 등에 대한 연구들이 있어 왔으며 최근에는 수술 기법의 발전 및 적절한 예방적 항생제의 투여가 가장 중요한 요인으로 강조되어 지고 있으며 적절한 항생제 투여시 골반강내 도관 삽입에 의한 배액술의 효과에 대해서는 아직 많은 연구가 필요하며 이에 저자들은 본 연구를 통하여 다음과 같은 결론을 얻었다. 1. Hemovac 제거시 말단부의 균 배양 검사 결과 균의 동정이 관찰되지 않는 경우가 76예(75.5%) 나타났고, Staphycococcus coagulase negetive가 17예(17.0%), Enero coccus faecalis가 4예(3.9%) Pseudomonas 1예(0.9%), Xa nthomonas maltophilia 1예(0.9%), Candida albicans 1예 (0.9%) Klebsiella pneumonia 1예(0.9%)가 각각 동정되었 으며 Staphylococcus coagulase negative균의 동정은 inci dental contamination의 결과라고 여겨지며 합병증의 발생 유무는 Staphylococcus coagulase negative 균의 동정유무 에 따른 두 군간의 유의한 차이는 보이지 않았다. 2. 양측골반임파절 절제술을 포함한 부인암 수술 후 Hemovac suction drain을 삽입하였던 환자 중 합병증이 나타난 예는 총 37예(42.%)였으며, 방광무력증 19예 (17.0%), 창상열개 12예(10.6%), 요로감염 5예(4.5%), 급 성담마진 3예(2.7%),심한 설사 2예(1.8%), 도관삽입부의 감염 1예(0.9%), 호흡곤란 1예(0.9%) 도관삽입부로의 암 전이 1예(0.9%), 외래 추적 관찰중 임파낭종이 발견된 경 우가 3예(2.7%)였다. 대부분의 합병증은 보존적 치료로 호전되었으며 임파낭종 중 1예는 경피적 흡입술을 시행 하였다. 이들 합병증을 균이 자라지 않은 군과 균이 자란 군으로 구분하여 볼 때 각군에 유의한 차이는 없었다 (P=0.0731). 그러므로 부인암 수술 후 적절한 항생제를 투여하는 경우 Hemovac 제거시 말단부의 균배양 검사는 불필요한 것으로 사료된다. In preantibiotic era, pelvic drains had been utilized to decrease the postoperative complications such as febrile morbidity, fistula and lymphocyst formation, wound dehiscence due to pelvic infection. Nowadays, prophylactic antibiotics, transfusion, improved surgical technique and proper anesthesic management are being done for the prevention of postoperative complicatons. In Severance hospital hemovac drains was introduced in the early 1980`s and has been used since then. The purpose of this study was to evaluate the effectiveness of Hemovac tip culture study after radical hysterectomy with pelvic lymphadenectomy by reviewing 102 patients who took radical hysterectomy with pelvic and paraaortic lymphadenectomy at Severance hospital from March 1990 to December 1994. All of those patients had Hemovac drains inserted. Postoperative complications are compared according to the Hemovac tip culture results, and the significance of the tip culture will be studied. The postoperative complications were found as the following: Bladder atony that needed rehabilitation department consultation in 19 cases (17%), wound dehiscence in 12 cases (10.6%), urinary tract infection in 5 cases (4.5%), hemovac insertion site infection in 1 case (0.9%), lymphocyst formation in 3 cases (2.7%), cancer metastasis to hemovac insertion site in 1 case (0.9%). After the removal of hemovac drains, tip culture was routinely performed. In 76 cases (75.5%) no growth was noted, colonization of Staphylococcus coagulase negative growth in 17 cases (17.0%), Enterococcus faecalis growth in 4 cases (3.9%), Pseudomonas growth in 1 case (0.9%), Xanthomonas maltophilia growth in 1 case (0.9%), Candida albicans growth in 1 case (0.9%) and Klebsiella pneumonia growth in 1 case (0.9%). No statistical correlation could be found between the hemovac tip culture positive group and the incidence of ostoperative complication. Therefore as a conclusion, hemovac tip cultures are not mandatory for the purpose of postoperative complication surveillance if proper antibiotics coverage is done after surgery.

침윤성 자궁경부암에서 p53 과발현에 관한 연구

김수녕,박찬규,김호근,이성기,손인숙,김종석 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

The p53 gene is a tumor suppressor gene and mutations in this gene play an import-ant role in the development of many human malignancies. The purpose of this study was to investigate the overexpression of p53 protein as a prognostic factor in invasive cervical cancer. Forty-three formalin fixed, paraffin wax embedded blocks of invasive cervical can-cers were examined using immunohistochemical staining with a monoclonal antibody against p53. The result were as follows: 1. Immunostaining for p53 consistent with overexpression was seen in 23.8%(5 of 21) of stage Ⅰ cancers and in 13.7%(4 of 22) of stage Ⅱ cancers. 2. Immunostaining for p53 consistent with overexpression was seen in 21.6%(8 of 37) of squamous cell carciomas and in 0%(0 of 6) of adenocarcinomas. 3. The incidence of p53 overexpression was 25.0%(1 of 4) in cases with lymph node metastasis, compared with 17.9%(7 of 39) in cases without lymph node metastasis. 4. The incidence of p53 overexpression was 20.0%(8 of 40) in cases with less than 4 cm, compared with 0%(0 of 3) in cases with equal to or larger than 4cm. In conclusion, p53 overexpression was not associated with stage, histologic type, and tumor size. However, there were trend for p53 overexpression to increase in patients with lymph node metastasis.

임신과 합병된 전신성 홍반성 낭창 1 예

김수녕,김두호,조인제,유근재,김경수 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

건국대학교 의과대학교부속 민중병원 산부인과에서는 출산후 고열이 지속된 23세의 초산부에서 신중후군을 동반한 전신성 홍반성 낭창 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Systemic lupus erythematosus is a multisystem, antibody mediated, autoimmune disorder that has a predilection for women of child bearing age may potentially complicated pregnancy. Maternal and fetal risks have been difficult to evaluate because of the unpredictable nature of the disease and limited individual experience.The relationship between systemic lupus erythematosus and pregnancy is controversial and the renal invilvement is a major source of morbidity and death. The increased morbidity and mortility occur in general in the first two years after delivery. The present report documents the case of a 24 years old primigravida woman in IUP at 41 weeks proven systemic lupus erythematosus after delivery and a review of the literature is presented.

간의 우엽에서 발견된 복강임신

김수녕,이성기,손인숙,김종석,함희원,윤상애 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.5

Abdominal pregnancies are rare forms of ectopic pregnancies. Although the pelvic cavity is the preferential site, a small fraction of abdominal pregnancies has been found in the upper abdominal cavity, e.g., the omentum, the spleen, the liver etc. In this manuscript, we first report a Korean case of hepatic pregnancy which was highly suggested by operative findings. A 24-year-old woman underwent laparotomy under the impression of hemoperitoneum and ectopic pregnancy. An 1 x 1x 0.5cm sized mass was removed from the surface of the right lobe of the liver. Microscopically, the chorionic villi were demonstrated. The patient had a successful recovery.

자궁내막증 및 자궁근종을 동반한 난소 투명세포암 1 예

김수녕,김두호,최범채 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.3

자궁내막증 및 자궁근종을 동반한 난소 투명세포암 1예를 보고하고 이에 대한 문헌고찰을 하였다. In 1973, a committee of the World Health Organization chose the term $quot;clear cell adenocarcinoma$quot; to avoid the histogenetic confusion implied in the term $quot;mesonephroma$quot; coined by Schiller in 1939, Association with endometriosis, adenomyosis, uterine leiomyoma, endometrial carcinoma, and contralateral ovarian neoplasms was reported. A case of clear cell carcinoma of the ovary associated with endometriosis and uterine myoma is presented and the literature is reviewed.

부인과종양에서 뇨중 표피성장인자의 임상적 의의

김수녕,이성기,최범채,유근재,이원욱,김종석 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.4

Objectives : The purpose of this study was to get the clinical significance of urinary ocncentration of epidermal growth factor (EGF) of the patients with benign and malignant gynecologic tumors comparked to normal conterol group. Methods : We studied the urinary EGF levels in 73 patients with gynecologic tumors at MIn-joong General Hospital of konkuk univ. the colleted samples were treated by radioimmnunoassay thechnique. chi-square analysis and STudent`s t-test were used. significance was determined at the level of p$lt;0.05. Result : in 73 cases, benign gynecologic tumors were 54cases and gynecologic cancer were 19case (cervical cancer 8, ovarian cancer 8, other gynecologic cancer 3). the old in gynecologic cancers. The mean urinary EGF levels of the patients with benign gynlogic cancers.The mean urinary EGF levels of the patients with bengin gynecologic tumors was 16.4+-6.6ng/mg. creatinie, and 16.1+-4.7ng/mg. creatinine in gynecologic cancers (15.3+-4.3ng/mg. creatinine in cervical cancer, 16.4+-3.7ng/mg. cretinine in ovarian cancer), 16.7+-3.7ng/mg. creatinine in normal control grop. There was no sinificant difference in urinary EGF levels between control group and the patients with gynecologic tumors. There was no significant difference in urinary EGF levels between benign gynecologic tumors and gynecologic cancers. Conclusion : Our data suggest that urinary EGF may not be useful as a marker of gynecologic turmors.

Krukenberg 종양 1 례

김수녕,김두호,조인제,안미경,최영숙 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.6

저자 등은 위가 원발병소로서 양측 난소에 전이된 Krukenberg 종양 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Krukenberg tumor of ovary accounts for about 3~5% of ovarian tumors and most of the tumors are metastases from primary tumors of the gastrointestinal tract. We experienced one case that was presented of Krukenberg tumor metastatic from the stomach. Hereby, we report this case with a review of the literature of Krukenberg tumor.

자궁내막암의 임상적 및 외과적 병기설정에 따른 예후의 비교

김수녕,김정연,박찬규,김경수 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.10

이상의 결과로 보아 자궁내막암에서 외과적 병기 결정이 임상적 병기결정보다 질병의 파급정도 및 예후를 보다 정확히 평가할 수 있을 뿐아니라, 예후인자의 유무에 따라 보조치료의 필요성을 결정하여 자궁내막암 환자의 5년생존률을 높이는데 기여할 수 있을 것으로 기대된다. This study is based on a retrospective review of 51 patients with endometrial carcinoma from Jul. 1976 through Jan. 1993 who were admitted to the Dept. of Obstetrics and Gynecology, Yonsei University College of Medicine. All cases were clinically staged and 37 cases were retrospectively restaged using FIGO surgical stagin. The FIGO clinical stage distribution for this study was as follows: 37(72.5%) Stage I, 8(15.7%) Stage II, 6(11.8%) Stage III> Surgical staging of 37 cases revealed 25(67.6%) Stage I, 5(13.5%) Stage II, 6(16.2%) Stage III, 1(2.7%) Stage IV patients. Surgery upstaged 10.7% of clinical stage I. In clinical stage II, 20% were upstaged. In clinical stage III,25% were upstaged. No downstagin occurred in all stages. Twenty one surgically staged patients received no adjuvant therapy. The remaining 16 patients had adjuvant treatment which consisted of radiotherapy(62.5%), chemotherapy (25%), combined modality treatment(12.5%). Five-year survival by clinical staging was as follows: 69.3: for Stage I, 52.5% for Stage II, 29.2% for Stage III. Five-year survival by surgical staging was as follows: 95% for Stage I, 45% for Stage II, 19.05% for Stage III. Poor histologic grade and myometrial invasion appear to be significant prognostic factor and surgical staging ois the strongest predictor of survival. In summary, this study demonstrates that surgical staging is indicated to accurately determine the initial extent of disease in endometrial carcinoma.