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유도 분만에서 ProstaglandinE2의 경관내 삽입 및 질좌제의 임상적 효과 비교
상미란(Mi Lan Sang),권용일(Yong Il Kwon),박태철(Tae Chul Park),권동진(Dong Jin Kwon),이용석(Yong Suk Lee),배태욱(Tae Wook Bae),이진우(Jin Woo Lee),김수평(Su Pyung Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10
목적: 임신말기 유도 분만에 있어 Parity 및 Bishop-score에 따라 endocervical PGE2 및 vaginal PGE2의 임상적 효과를 비교하여 endocervical PGE2가 경관 숙화 및 분만유도에 더 효과적이라고 판단되어 본 연구를 시행하였다. 방법: 1998년 3월부터 9월까지 가톨릭 대학교 부속 의정부 성모병원 산부인과에 입원한 65명 산모를 대상으로 무작위로 추출하여 Parity 및 Bishop-score에 따라 3mg Dinoprostone을 경관내 및 질 후원개부위에 8시간 간격으로 최고 3개까지 삽입하여 규칙적인 진통이 유발될때까지 시행하였다. 결과: endocervical PGE2가 경관숙화 및 분만유도에 있어 더 확연한 효과를 보였다. 나이, 임신주수, 분만력, 초기 경관숙화정도는 두 군에 차이가 없었고 제왕절개율, 태아가사, 자궁과수축, 부작용도 차이가 없었다. 진통시작까지 걸린 시간에서 경산부에서 endocervical PGE2를 삽입한 경우가 다른 군보다 유의하게(p=0.0195) 짧았고 active labor까지 가는데 걸리는 시간은 초산부에서 endocervical PGE2를 삽입한 경우가 다른군보다 유의하게(p=0.0245) 짧았다. 또한 경산부에서 진통 시작까지 걸린 시간과 active labor까지 가는데 걸리는 시간, B-score 8점까지 되는데 걸린시간이 통계적으로 유의하게 짧았다. 요소간 분석을 보면 분만력, oxytocin등이 영향을 미칠 수 있고 그 중 투여방법이 가장 중요한 요인으로 추정되었다. 결론: 본 실험에서 경관 숙화가 안된 경우에 유도분만에 있어서 PGE2의 경관내 주입이 질정보다 효과가 좋으며 태아곤란증이나 제왕 절개분만, 신생아에 대한 영향에 차이가 없는 것으로 종합하여 보면 PGE2의 경관내 투여는 권장할 만한 가치가 있으며, 효과적인 유도분만에 유용하리라 사료된다. Objectives: The trial was performed to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E2(PGE2) in the case of parous and nulliparous woman with favorable and unfavorable cervical features. This study was performed to determine the clinical usefullness of endocervical PGE2 comparing with the vaginal PGE2 in cervical ripening and induction of labor. Method: The randomized trial with 65 Participants was performed with sealed envelopes for parity and Bishop score (from March to september, 1998). PGE2 tablet(3mg Dinoprostone) was administrated intravaginally to the 32 pregnant women and endocervically to the 33 pregnant women every eight hours with maximum three times until the regular labor develped. Result: Outcomes of labor and delivery were clearly related to cervical score at trial entry. endocerval PGE2 had a more marked effect on cervical ripeness than did vaginal PGE2. There were no significant differences on age distribution, gestatioanal period, primiparity, cervical status, initial B-score in each group. There were no significant differences in cesarian section rate, fetal distress, uterine hyperstimulation, side effect and poor infant outcome between the groups The mean induction time was statistically shorter in cervical group with multiparous women than other group(p=0.0195). In the induction-active labor time, cervical with primi group was statistically shorter than other group(p=0.0245). Statistically significant differences were noted between the nulliparous woman and multiparous women in mean induction time, induction-active labor time, time to B-score 8. In the factor that effects induction-active labor, route was significantly better than other factor.(p=0.0001) Conclusion: edocervical PGE2 is more effctive than vaginal PGE2 in cervical ripening and induction of active labor. the endocervical PGE2 resulted in a significantly shorter induction to active labor time compared with vaginal PGE2 and has almost no side effect. Because differences in effectiveness between endocervical and vaginal PGE2 are marginal, preference of woman and clinicians can the choice between them.
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남궁성은(Sung Eun Namkoong),이준모(Joon Mo Lee),이상희(Sang Hee Lee),배태욱(Tae Wook Bae),이노준(No Jun Lee),김찬주(Chan Joo Kim),박태철(Tae Chul Park) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3
N/A Objectives: The purpose of this study is to investigate the clinicopathologic characteristics and the risk factors affecting the recurrence in patients with borderline ovarian malignancy. Methods: From January 1996 to January 2001,37 patients with borderline tumors of the ovaries were retrospectively investigated in the Department of Obstetrics and Gynecology, Catholic University, Kangnam and Uijongbu St. Mary's Hospital. Several clinicopathologic factors including DNA ploicly was analyzed for the prognosis and recurrence. sAnalysis for the kinds of treatment and recurrence were conducted to test the prognostic significance of several clinicopathologic factors including DNA analysis. Results: Histologically, 27 borderline tumors were serous,9 were mucinous and 1 was mixed epithelial type. The FIGO stage I was 91.8%(34/37)and stage II was 8.2%(3/37).Mean value of CA125 in mucinous borderline malignancy was significantly higher (162.4 IU/mL)than serous types (52.2 IU/mL)(p<0.05). The patients with elevated CA 125 levels (>35 IU/mL)were 56.3%(9/16)in serous type and 75%(6/8)in mucinous tumors. Ten of 13 cases with DNA flow cytometry showed aneuploidy (76.9%).When considering pathologic types between diploid and aneuploid groups, there were no statistically significant differences. However, the patients with old age (>40) were more likely to be aneuploid (p<0.05).Mean duration of follow-up investigation was 26 months after primary operation. In this period, only one patient with serous borderline tumor stage Ia had recurrence on the contra-lateral ovary at 13-month. Conclusion: Data from this study showed that the majority of borderline tumors have good prognosis. And young patients who have not completed childbearing can be safely treated with unilateral salpingo-oophorectomy and omentectomy in stage I diploid tumor. In ovarian bordeline tumors, further studies on DNA ploidy would be needed.
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