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

10대 여성의 임신 및 유산에 관한 의학적 고찰 ( II )

박인서(IS Park),엄승호(SH Ohm),차인환(IW Cha),정병철(BC Jung) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.1

조사대상은 대도시 종합병원에서 엄격히 선별하였다. Nowadays industrialization and a complex urban society unduly prolong education and delay marriage and sexual gratification. Teenage reach sexual maturity at an earily at an early age, leaving a 5-10 year gap between sexual maturity and sexual activity ligitimized by marriage. Furthermore little attention has been given to the adolescent who are more susceptible and vulnerable than adults in physical, socoeconomical, and psychogical aspects. For the purpose of obtaining the medical aspects of pregnancy and abortion in adolescence in Korea, 385 cases out of 28,688 deliveries at the 4 university hospitals in Seoul during the period of 1974-1978 were studies with demographic review of Korea population. The results were as follows: 1. The collection and study were carried out in 385 cases of teenage pregnancy out of 28,688 deliveries at the 4 uniuersity hospitals in Seoul. 2. The incidence of teenage pregnancy shows higher (1.3%) compared with other reports in Korea, because most of the sample resources included the referred cases married or resided with the foreigners, exclusively U.S.A. soldiers as the project of maternal and child health cares service. 3. More than tree-fourths of occupation of teenage gravida were Koreas housewife or foreigners wife (or partner). Excluding these 2 categories out of wedlock birth might occupied one fourth of sample size. 4. the average age of menarche was 14.3 years. 5. The parity of teenage gravida: nullipara were 332 cases(86.2%) and multipara were 52 cases(13.5%). 6. In the past medical history most of the teenage gravida had non-contributory one (88.8%), venereal disease was 4.0% and pelvic inflammatory disease was 2.6%. 7. 54.4% of 385 cases had more than one antenatal care 8. Fetal presentations were vertex (94.1%), breech (4.8%), face of brow(0.8%) and shoulder presentation (0.3%) respectively. 9. Modes of deliveries were vagina (84.3%) & c-section delivery (15.7%) respectively. The frequency of major obstetric complications in order were anemia (20%),toxemia(12%), PROM (9.5%), postpartum hemorrhage(9.1%) respectively. 11. 29 cases out of 385 cases were terminated pregnancy. Among them more than half cases (56.8%) were carried out in the first trimeste, 12 cases in the second trimester and none in the third trimester. 12. According to the modes of pregnancy interruption, more than half of cases (55.2%) were terminated by D & E. others wers by Bougie with pitocin & prostaglandin. Hypertonic saline method had not been used in these cases. 13. In the views of birth weight no higher incidence of prematurity (9.9%) is seen compared with that of matured mother. There was no significant difference between Koreans housewives and foreigners wives (or partners). 14. Consequence of baby: About three-fourths(74.5%) of baby turned out to be wanted baby, unwanted occupied 16.9%.

제왕절개 자궁적출술의임상적 고찰

박찬무(CM Park),박형무(HM Park),엄승호(SH Ohm),차인환(IW Cha) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.5

1. 제왕절개자궁적출술을 받은 환자 32예중 66%의 예에서 산과적 출혈에 의한 응급을 요한 수술이었다. 이의 적응증으로는 자궁파열이 6예로 18.75%를 차지하였고, 이완성 자궁출혈이 5예 (15.63%), 유착태반이 4예(12.5%) 전치태반에 의한 지혈곤란, 자궁근종, 자궁경부암 및 불임 목적으로 각각 3예씩 (9.38%)을 차지하였고 기타의 경우가 15.6%를 차지하였다. 2. 심한 출혈로 인한 쇼크 상태의 환자 즉 쿠베레어 자궁이나 지혈곤란의 경우에선 부분적 자궁적출술을 시행하였고 다발성 자궁근종의 경우는 출혈은 심하지 않았으나 수술상의 난점 으로 역시 부분적 자궁적출술을 실시하였다. 3. 수술후 21예(65.6%)에서 아무런 합병증이 없었으며, 합병증이 나타난 예에서는 창상감염 및 파열이 4예(12.5%)로 가장 많았고 요로감염 및 방광손상에 의한 방광무력증이 각각 2예 로 6.25%를 차지하였고, 그외 골반농양, 마비성 장폐쇄, 복막후강출혈등이 1예씩 있었다. 4. 산모사망은 2예(6.25%)로 비교적 높은 비율을 차지하였는데, 그중 1예는 수술중 지혈곤란 으로 사망하였고, 다른 1예는 패혈성 쇼크환자로서 수술후 골반농양, 장누공 및 패혈증으로 사망하였다. This study was undertaken to determine the present status of cesarean hysterectomy. Cesarean hysterectomy was originally devides to combat postcesarean infection and hemorrhage, and it indication have gradually been widended to include many conditions in which removal of the uterus is necessary or desirable. In this study the outcome of 32 cases of cesarean hysterectomy performed at National Medical Center during 18 years from Jan. 1962 to Dec. 1979 was discussed and evaluated. There were 21042 deliveries during this period. Cesarean hysterectomy was performed in 32 of 1360 cesarean section, an incidence of 2.35%. The incidence of cesarean section was 6.46%. The age of patients varied needed immediate emergency operations. In about 2/3 of total patients (65.6%) there were no postoperative complications There were 2 cases of maternal mortality in this series . They underwent cesarean hysterectomy for placenta previa and postpartum intrauterine infection, however, ond died of sepsis and the other of uncontrollable bleeding. To prevent these catastrophies periodic and meticulous antenatal care must be provided.

반복자궁외임신의 임상적 고찰

박인서(IS Park),유명숙(MS Yoo),엄승호(SH Ohm),강대웅(DW Kang) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.6

1. 반복자궁외임신의 빈도는 6.1%였으며 연도 별발생 빈도는 1960-64년을 제외하고 점차 증 가추세였다. 2. 반복 자궁외임신의 호발 연령은 32.0세였고 원발성 자궁외임신은 30.5세였다. 임신중절술 은 양 측 비슷하나 반복 자궁외임신 시 3.2회로 약간 높았다. 3. 양 군에서 마지막 월경후 50일전후에 수술을 받았다. 4. 동측에 반복 임신 되었던 경우는 3.2% 반대측 난관임신은 88.9% 중 팽대부가 52.4%을 차지하였다. 5. 총 63예 중 전자궁적출술이 8예였고, 환측 난관적출술은 44예였다. 6. 자궁내 및 자궁외 임신의 가임율은 30.8%였다. 7. 반복 자궁외임신은 총 63예중에서 3년이내에 발병은 46예(71.3%)로 약 2/3을 차지하였고, 3년 이상은 17예(27.0%)를 차지하였다. 8. 원발성 자궁외임신의 이환율은 7.9% 반복 자궁외임신은 12.6%를 나타내며, 원발성에서 모성 사망은 1예로 혈액량감퇴증이었고 반복 자궁외임신 예에서는 사망자는 한 예도 없었다. This is a review of 63 cases of repeat ectopic pregnancy for 20 years period from Jan. 1 1960 to Dec. 31, 1979, in National Medical Center. In a study of 1462 cases of ectopic pregnancy, sixty three patients (6.1%) experienced repeat ectopic pregnancy. The result of the study were as follows; 1. The mean age and duration from LMP to surgical treatment were 32.0 year and 51.0 days in cases of repeat ectopic pregnancy 2. Of these 63 cases of repeat ectopic pregnancy, hysterectomy was undertaken in 8 cases, salpingectomy 44, salpingo-oophorectomy 11, and other 1. 3. Subsequent pregnancy rate after first ectopic pregnancy was 30.8%. 4. the case of abortion was 6 and term pregnancy 7 in 63 cases 5. The mean interval between first ectopic pregnancy and repeat ectopic pregnancy was 2.4 years. 6. the morbidity was noted as 8/63 and mortaity rate was zero.

산부인과 영역에 있어서 초음파장치의 임상적 이용 ( I )

박찬무(CM Park),박영세(YS Park),김용철(YC Kim),박찬용(CY Park),엄승호(SH Ohm),이우홍(WH Lee) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.3

저자는 자궁내 태낭의 성장속도와 태아의 성숙도 및 태아예상체중을 위한 방법으로 정상임 신부 422명중 63명에게는 태낭을 위해 1회의 초음파 단층촬영을, 359명에게는 아두대횡경치 를 위해 1회의 초음파단층촬영을 실시했고 아두대횡경치에 의한 태아 예상체중을 위해 신생 아 97명의 분만후 24시간내에 신생아 체중을 계측하여 임신월령에 따른 태아 아두 및 예상 체중의 희귀직선을 산출하여 다음과 같은 결론을 얻었다. 1. 임신재태기간 제 5주부터 12주사이의 정상임신부에서 태낭은 제 5주에 5명중 3명에서 (66%) 제 6주는 9명중 7명에서 (77%) 최초로 태낭이 보였고 7주 이후에서는 모든 예에서 태 낭이 관찰되었다. 2. 임신재태기간 제 5주부터 12주까지 임신주수에 다른 태낭의 성장은 y=0.62 X (wks) - 1.75로 0.57cm/week의 비율로 성장한다. 3. 임신재태기간 제 11주부터 40주까지 임신주수에 따른 아두대횡경치는 y=0.27 X (wks) - 0.88로 성장하고 임신재태기간 제11주부터 20주까지는 0.34cm/week로 제 21주부터 40주까지 는 0.23cm/week의 증가율을 나타낸다. 4. 임신제대기간 제 35주부터 40주까지 각 임신주수에 다른 아두대횡경치에 의한 아두대횡 경치에 의한 태아 예상체중은 y=1.14 X (mean BPD) - 7.2(kg)로 0.16kg/week의 증가율로 나타난다. The ultrasonic measurements of fetal biparietal diameter (BPD) were obtained by real time scanning (ADR 2130) from 380 times in normal 359 pregnant women between 11th to 40th gestational weeks. Before 11th gestational weeks of pregnancy, gestational sac was measured by same method from 81 times (63cases). The results of these data were as follows; 1. the regression line according to the increment of gestational sac between 5th and 12th gestational weeks; y=0.62 X (wks) - 1.75. 2. The regression line from 11th to term of biparietal diameter ; y=0.27 X (wks) - 0.88 and the growth rate of the biparietal diameter during same period (0.34cm/week) was faster than one of 21th-40th gestational weeks (0.23cm/week). 3. The expected fetal body weight was calculated from the regression line (y=1.14 X (mean BPD) - 7.2(kg)) was obtained from sonar measurement of biparietal diameter (from 35th to 40 th gestational weeks).