Doo`s SACSIH Operation방법에 의한 새로운 자궁적출술

두재균(JK Doo) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.7

Hysterectomy has been one of the most frequent surgical operations since Freund succeeded in it for the first time in 1878. Diseases for which hysterectomy is found efficaciuous are uterine myoma(40-60%)and other disease such as DUB, Endometriosis Adenomyosis PID,etc. There have been the 239 cases of hysterectomy due to benign uterine disease in 1992 at the department of Obstrics and Gynecology, Chonbuk National University Hospital and it is supposed that there are tens of thousands of women in thirties and forties who go through hysterectomy each year. It is mostly young women in thirties and forties who go though the operation: more than 70%, and they afterwards reported psychological conflict and sexual disssatisfaction stemming from loss of their uterus. I modified Kurt Semm`s CASH and devised a different surgical operation to work out women`s problems after hysterectomy. What characterizes Doo`s SACSIH(Subtotal-abdominal-Cylindrical resection of-Squamocolumnar junction in-Intracervical-Hysterectomy) operation is, fist, that while CASH is done under laparoscopy Doo`s SACSIH operation is, considering edonomical, technical as pect involved in operation, done under laparotomy and, second, to remove cylindrically transformation zone and endocervical columnar epitheelium, using the instrument I devised by modifying Semm`s and therby making it more convenient for use and, third, to remove uterus in upper one-third cervix and make a stump out of the remaining cervix composed of pure fibromuscular tissues. Doo`s SACSIH operation still has strength that the existing sub-total hysterctomy has had and will, at the same time, eliminate the possiblity of getting stump cancer that can be developed after the operation. The twenty-nine patients have been operated by Doo`s SACSIH operation method between the 18th of November of 1992 and the 12nd of May of 1993 and the results have been highly satisfactory.

Doo`s SACSIH 수술과 전자궁적출술후 환자와 배우자가 느끼는 심신의학적인 면에서의 비교연구

두재균(JK Doo),이민아(MA Lee),박경배(KB Park),채규정(GJ Chae),김관식(KS Kim),안석문(SM Ahn),유은영(EY Yoo),김난경(NK Kim),나미옥(MO Na) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

Since November 18 of 1992, we have undertaken a comparative study concerning the patients and their spouses at least five months after the operation. We chose 31 patients who were operated by Koos SACSIH operation and the same number of the patients who and psychsomatic aspects occured after each operation. And we cmae to the following conclusion: 1 Of the patients subjective complaints, weight gain was the highest after Koos SACSIH:32.3%; decrease in sexual desire was the highest after TAH: 29.1%. 2. 51.6% of the patient after Koos SACSIH had no complaint of pelvic pain and lumbago and 32.3% after TAH. 3. 19.3% of the patients after Koos SACSIH complain of decrease in sexual desire and 32.3% after TAH. 4. 33.3% of the patients in their forties after Koos SACSIH had coital frequency less than once in 2 weeks and 78.9% after TAH(PP

Modified Doo`s SACSIH Operation , 자궁경부 내강조직 제거용 Electrode , 그리고 Hysterectomy Scoring System에 대한 연구

서성진(SJ Seo),김태실(TS Kim),두재균(JK Doo) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

The methods of hysterectomy for intrapelvic benign disease include total, subtotal, la-paroscopic-assisted transvaginal, and SACSIH operation. There have been 298 cases of SACSIH operation for benign uterine or pelvic diseases at the Chonbuk National University Hospital from November 16, 1992 to March 31, 1997. Patients were 41.8 years old on the average ranging from 29 to 50. Their indications cover uterine myoma(211), adenomyosis(37), uterine myoma with pelvic adhesion(16), uterine my- oma with endometriosis(11), and others(23), the uterine myoma being the most common. Both CIN and CIS is excluded after the full evaluation of the cervical disease through Pap. smear, cervicography, ECC biopsy, and HPV typing etc, and the consent of patient is secu- red. The modified SACSIH operation, when compared with other simple hysterectomy oper- ation, has the following advantages;1) minimal surgery, 2) easy adaptation, 3) avoidance of stump cancer, 4) rapid recovery and 5) less postoperative care as far as psychosomatic posthysterectomy problems are concerned. One of the new equipment for new modified technique is the Electro-Surgical Unit system with Electrode for endocervical canal resection. This is developed at this hospital as a part of the G-7 project supported by the Ministry of Health and Welfare. It is made of electrode and rod from electrosurgical unit system and operated by high frequency of current. Thus, we introduce, herein, the modified SACSIH operation and propose the postopera- tional scoring system to estimate postoperative sequelae and to help carry on personal well- being in terms of sexuality and normal life.

두씨색시수술 313 예에 대한 임상적 고찰

방해미(HM Bang),박종을(JE Park),서성진(SJ Seo),두재균(JK Doo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

The 313 cases of Doo`s SACSIH operation were performed at Chonbuk National University Hospital from the 16th of November in 1992 to 30th of June in 1997. The results were as follows : 1. The mean age of patients was 41.4±6.0 years old and most common age group were ranged from 40 to 49 years old (59%). 2. The mean parity of patients was 2.28±1.01 and most common parity group was 2 (50%). 3. According to the initial chief complaints, abnormal uterine bleeding were in 128 cases (41%), lower abdominal discomfort were in 70 cases (22%),dysmenorrhea were in 55 cases (18%), and no symptoms and signs were in 24 cases (8%). 4. Preoperative clinical diagnosis were myoma (70.3%), myoma with pelvic adhesion (9.3%), adenomyosis, adnexal tumor, endometriosis, TRD, endometrial hyperplasia in orders. 5. According to the histopathologic type, there were 184 cases (58.8%) of leiomyoma, 93 cases (29.7%) of adenomyosis, 9 cases (2.9%) of myometrial hypertrophy, 5 cases (2.2%) of adnexal tumor, and 10 cases of no symptoms and signs. 6. According to the postoperative complications, there were 48 cases (15.3%) of febrile morbidity, 10 cases (3.2%) of wound infection, 6 cases (1.9%) of cervical bleeding, and 2 cases (0.6%) of stump cancer. 7. The mean hospitalization were 8.47±1.06 days. 8. The mean operation time was 97.72±22.59 minutes.

난관복원술의 성공율을 높이는 제반여건의 고찰

차경연(KY Cha),양재이(JI Yang),류철희(CH Rhyu),두재균(JK Doo),김종덕(JD Kim) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.6

For evaluation of factors that influence the success rate of tubal reversal, 116 cases of microsurgical reversal were investigated, which were performed at the infertility clinic in the Department of Obstetrics and Gynecology, Chonbuk National University Hospital from March 1982 to February 1990. 106 cases were able to follow up more than 6 months among these 116 cases of tubal reversal patients. The results were as follows; 1. The pregnancy rate was 84.9%(90 patients) in 106 cases of tubal reversal. 2. The most common incentive was the loss of their children(75.5%), but since 1987 remarriage(24.6%) and change of marital attitude(20.0%) were increasing steadily. 3. After tubal reversal, the mean age of pregnant patients was 28.5 years and that of non-pregnant patients was 30.3 years(p<0.05). 4. The time interval between the sterilization and the tubal reversal was 35.5 months in pregnancy groups, 42.4 months in non-pregnancy groups(p<0.05). 5. The mean length of reconstructed tube was 8.3 cm in pregnancy patients, 6.8 cm in non-pregnant patients(p<0.05). 6. Referring to the sterilization types, the pregnancy rate was higher and the length of reconstructed tube was longer in those who underwent tubal ligation with Falope ring. 7. Referring to the site of anastomosis, the pregnancy rate was higher in ampulloampullar, cornu-ampullary, isthmo-isthmic anastomosis than other group(p<0.05). 8. The pregnancy rate within the first year after tubal reversal was 95.5%, but no case after 2 years was noted. 9. Postoperative tubal pregnancy developed in one case(0.9%) after tubal reversal. 10. Kim`s clamp and Doo`s microirrigator were considered to be valuable instruments in tubal surgery.

가토자궁의 조직손상시 유착에 영향을 미치는 제반 약물에 관한 연구

두재균(JK Doo),김종덕(JD Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.7

가토를 이용한 실험에서 복강내 장기수술후 첨가물질이 유착에 미치는 영향을 보기 위하여 첨가물질별 복강내 장기유착 정도, 복수존재 유무, 조직학적 소견 등을 관찰하여 다음과 같 은 결론은 얻었다. 1. 복강내 첨가물질별 조직의 유착정도는 대조군에 비해서 SCMC과 hyskon군이 적었으며, 이중에서 SCMC군의 유착방지 효과가 우수한 것으로 나타났다. 2. Talcum powder군은 모든 실험군중에서 가장 심한 복강내 유착을 일으켯다. 3. 복수형성은 talcum powder군에 가장 심하였다. 4. 자궁에 대한 인위적 손상중 전기소작에 의한 소상이 나일론 봉합과 절상 등에 비해서 조 직유착이 더 심한 것으로 나타났다. 5. 조직구와 대핵 거대세포의 침윤과 섬유화 등의 조직반응은 talcum powder군에서 가장 심 했으며, SCMC군과 hyskon 군은 대조군보다 적었다. 이상과 같은 결과로 복강내 첨가물질에 의한 수술후 유착방지 효과는 SCMC군과 hyskon군 이 우수하였고 조직학적 반응과 섬유화가 가장 적어서 부인과 영역에 있어서의 불임환자의 난과성형술 및 수술후 유착방지를 위한 목적으로 사용하는 것이 바람직하다고 사료되었어므 수술용 장갑에 묻어있는 talcum powder는 수술후 심한 유착을 일으키므로 수술에 임하기 전 완전히 세척하는 것이 필요한 것으로 사료된다. To study the effects of adjuvants agent on the formation of postoperative adhesions 20 rabbits were randomly divided into five group ; a control group (n=4) a normal saline group (n=4), a hyskon group (n=4), a sodium carboxymethylcellulose group (n=4), nad a talcum powder group (n=4). All of the animals were received standardized injuries, and adhesions , presence or abscence of ascites, and histologic response were compared, and the results were as follow; 1. Adhesions were significantly less in the sodium carboxymethylecellulose and hyskon groups than the control group . When the groups were compared according to the adjuvants, the least adhesion was noted in the sodium carboxymethylecellulose group 2. There was the most pronounced adesions in the talcum powder group . 3. Ascites were founded considerably in the talcum powder group . 4. Adhesions were marked at the cautery site compared to the nylon stitch and incisional wound among artificial injuries. 5. Tissue responsiveness assessed by infiltration of histocyte and multinucleated giant cells, and fibrosis in histologic examination was the most pronounced in the talcum power group , while being less in the sodium carboxymethylecellulose and hyskon group than the control group.

미세수술을 이용한 가토난관 복원술시 사용된 봉합사 및 복강내 첨가물이 난관조직에 미치는 영향

김종덕(JD Kim),두재균(JK Doo) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.4

미세수술을 이용한 난관 문합술시 봉합사, 복강내첨가물, 수술 후 경과기간별로 난관조직의 유착정도, 봉합사의 흡수유무, 복수존재유무, 난관유통검사, 조직학적 소견을 관찰하여 다음과 같은 결과를 얻었다 1 난관정도의 유착정도는 vicryl군과 nylon군이 dexon군에 비하여 약간 적었으나 유의한 차이는 없었고(P=0 1504), macrodex군이 생리적 식염수군과 대조군보다 비교적 적었으나 유의한 차이는 없었다(P=0 8325) 2, 봉합사별 흡수유무는 수술 후 60일에서 vicryl군은 완전흡수, dexon군은 1마리(16 7%)에서 부분흡수, nylon군은 전혀 흡수되지 않았다(P=0 0002) 3 난관유통성 검사결과는 vicryl군과 nylon군이 dexon군에 비해서 약간 우수하였으나 유의한 차이는 없었고(P=0 6218) macrodex군이 생리적 식염수군과 대조군에 비하여 우수하였다(P=0 048) 4 복수는 수술 후 60일에 macrodex군의 50%(3/6)에서 존재하였으나 생리적 식염수군과 대조군에서는 없었다 수술 후 60일과 90일의 경과기간에 따른 차이는 없었다(P=0 2059) 5 조직구와 다핵거대세포의 침윤에 의한 조직 반응과 섬유화는 vicryl군과 macrodex군이 각각의 비교군보다 적었다 이상과 같은 결과로 봉합사로는 vicryl과 nylon을 사용하고 복강내 첨가물로는 6% dexon을 주입하였을 때 조직의 유착이 적고 난관의 유통성이 우수하며 조직반응 및 섬유화가 가장 적어 난관의 미세복원수술에 이들의 사용이 좋을 것으로 사료되었다 Tubal sterilization has been increased progressively in young reproductive women and it has made tubal reversal using microsurgery increase consistently Pregnancy success rate by tubal reanastomosis using microsurgery has been reported approximately two times higher than the previous operation methods Microsurgical tubal reanastomoses were performed on bilateral fallopian tubes of 18 female rabbits using different suture materials and adjuvants Adhesions, absorption of suture materials, tubal patency, and presence of ascites were compared and tissue responsiveness was evaluated by histologic examinations of the restored tubes, and the results were as follows: 1 There was no difference in the degree of adhesion of the restored tubal tissue when the groups were compared according to the suture materials(P=0 1504) and the adjuvants(P=0 8325) 2 Absorption of suture material was marked in the vicryl and the dexon groups compared to the nylon(P=0 0002) 3 There was no difference in tubal patency between the vicryl, dexon, and nylon groups(P=0 6218), but more cases with free flow were found in the macrodex group compared to the normal saline and the control(P=0 048) 4 Ascites were observed in 50%(3/6) in the macrodex group on the 60th day after reanastomosis, whereas none was found in the normal saline and the control(P=0 0735) No difference was noted in the frequency of ascites between the 60 days and 90 days groups(P=0 2059) 5 Tissue responsiveness assessed by infiltrations of histiocytes and multinucleated giant cells, and fibrosis in histologic examination was less marked in the vicryl and the macrodex groups compared to corresponding group

임신성 융모성질환에서 사용된 화학요법약독성에 관한 임상적 고찰

조용현(YH Cho),두재균(JK Doo),김종덕(JD Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.3

1981년 1월1일부터 1987년 12월 31일까지 7년동안 전북대학교병원 산부인과 융모성질환크리 닉에 등록된 환자 총 200명중단독이나 복합 화학요법을 받고 추적조사가 가능하였으며, 진 료기록지가 충실했던 48명을 대상으로 설문조사 및 진료기록지 참조형식에 의한 후향성 조 사방법을 이용하여 화학요법시 초래된 독성에 대한 임상증상과 검사소견을 분석검토한 결과 다음과 같은 결론은 얻었다. 1. 호발연령은 20-30세(49.9%)였고, 평균연령은 35.4세이었으며 화학요법 대상자중에서는 융 모상피암이 가장 많았고 (24명, 50%) 2. 발생빈도가 높은 혈액형은 AB형과 B이었다. 3. 내원 당시의 주소는 질 출혈이 32명(66.6%)으로 가장 많았다. 4. 치료결과 완전 경쾌율은 28명(58.3%)이었고, 사망은 4명(8.3%)이엇다. 5. 차기 화학요법약을 투여하기까지의 간격은 평균기간이 17.9+-3.6일 이었고 평균회수는 3.7 회 이었다. 6. 화학요법약 독성에 의한 임상증상으로는 오심, 구토, 구내염, 발열 등은 치료시작 3-4일경 에 시작하여 7일 전후에 극심하엿고, 14일이내에 소실되었다. 7. 검사소견으로 골수기능 저하는 치료후 14일에도 완전회복의 양상은 보이지 않고 간 기능 은 치료후 14일이면 회복되는 양상을 보여주고 있었으며, 신장기능에 대한 독성 영향은 거 의 없는 것으로 사료된다. 8. 화학요법회수가 반복될수록 잔류독성이 누적되어 출현하는 것으로 나타났으며, 그 출현시 기와 소실시기는 서로 비슷하였다. 이상과 같은 결과로 화학요법약 독성은 투여 종료후 최소 2주이상은 지속되는 것으로 보이 며, 약제에 대한 감수성, 전신 건강상태 등을 최우선적으로 고려해야 하겠지만, 독성을 줄이 고 치료효과를 높이기 위해서는 치료간격은 전 치료종료후 2-3주정도가 좋을 것으로 사료된다. To evaluate the toxicity of chemotherapeutics used in gestational trophoblastic disease, retrospective clinical analyses of 48 patients were performed by review of chart and questionair amon 200 patients who were enrolled to gestational trophoblastic disease clinic of the Department of Obsterics and Gyunecology, School of Medicine, Chonbuk National University Hospital during 7 years though January 1, 1981 to December ,31 1987. The results were as follows; 1. Gestational trophoblastic disesas was found most frequency in 21 to 30 age group (47.9%) with mean age of 35.4 years. The most frequency chemotherapeutics was given to choriocarcinoma (24cases ,50%). 2. Gestational trophoblastic disesas was prevalent in AB and A blood type. 3. the most frequency chief complaint at first visit was vaginal bleeding (32cases, 66.6%). 4. Complete remission rate was 58.3%(28cases) and 4 cases (8.3%) were died. 5. The mean log period of chemotherapy was 17.9+-3.6 days and the mean course was 3.7 6. Nausea, vomitting , stomatitis and fever were appeared around 3rd to 4th chemotherapy day with peak at 7th day and disappeareance at 14th day. Alopecia was appeared around 8th day with peak at 25th day and disappearance around 9th week. 7. Suppression of bone marrow function was not completely recovered by 14th postchemotherapy day while the liver funcion test being resumed by 14th postchemotherapy day. 8. Accumulative toxicity was appeared as the course was repeated with similar pattern.

TRISORB 봉합사와 기존 봉합사 ( Vicryl , Dexon , Medifit ) 의 매듭강력 및 가토생체조직을 이용한 조직분해반응에 대한 비교실험 연구

정소망(SM Jeong),두재균(JK Doo) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

Objective:Our purpost was to study effectiveness and clinical application of TRISO-RB suture materials and the find the most appropriate coating ingredient. The tensile str-ength and histologic reaction of the TRISORB are compared with those of traditional ma-terials such as Dexon , Vicryl , and Medifit . Study design:In vivo, 20 female rabbits were observed for histologic reaction at di- fferent time intervals after they were implanted with suture material. In vitro, Tensile str- ength was compared among the four suture materials after boiling in distilled water at 80 ℃. It was also compared with the tensile strength in phosphate buffer solution of pH 7.4 at 37℃. Results:Histologic reaction was remarkable with Medifit suture material. There was no significant differences among the other suture materials. TRISORB with A coating ingredient showed the least histologic reaction. TRISORB suture materials showed simi- lar tensile strength as those of traditional suture materials in vitro. Conclusion:TRISORB suture material is consists of same polyglycolic acid as trad- itional synthetic absorbable suture materials. It shows no significant differences in vivo and in vitro when compared with other traditional materials. It is considered to be applic- able with humans.

골반경하에 처치한 난소임신 1 예

조장철(JC Cho),서성진(SJ Seo),두재균(JK Doo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

Ovarian pregnancy is one of the rarest types of extrauterine pregnancy, which is difficult to diagnose clinically and even intraoperatively. Clinical presentations of ovarian and tubal pregnancies are similar and differentiation can be made only after microscpic examination of tissue specimens. Ovarian pregnancy occurs within the ovary and on the corpus luteum, usually with rupture of the ovary and a massive hemoperitoneum. We report a relatively intact ovarian pregnancy with laparoscopic removal with a brief review of the literatures.