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이봉구,이영혜,오병전 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.1
난소미분화배세포종은 비교적 젊은여성에서 흔한 난소의 악성종양으로 적절한 외과적치료와 방사선치료로 좋은 결과를 나타내지만 장차 아이를 원하는 경우, Stage IA라도 암의 진행상태에 따라 추가치료가 필요한 경우 및 진행된 종양, 그리고 재발된 경우에 보조직 항암요법 및 종양표시물질(LDH 및 β-hCG)를 이용한 질병의 추적을 하여서 좀더 환자의 생존율을 높이고 남아있는 난소의 보존을 기할것으로 사료되어 앞으로 항암요법과 방사선요법간의 효과에 대한 임상적시도가 더 필요할것으로 보겠다. Dysgerminoma is the most common pure malignant germ cell tumor of the ovary . Recently the survival of patient with advanced disease and recurrent disease treated by platinum based combination chemotherapy after operation was comparable with that of patients who received radiation operation. We had experienced two cases of advanced dysgerminoma treated by postoperative radiation and postoperative chemotherapy. So. Here we report above cases with brief review of literature.
조산 억제제로서의 Ritodrine Hydrochloride (Yutopar) 의 임상적효과
이봉구,이영혜,오병전,서승식,공지원 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.4
저자들은 1986년 1월부터 1987년 4월까지 조기진통의 진단하에 전주예수병원 산부인과에 입원한 산모에서 Ritodrine투여를 시행하고 분만시까지 추적된 25명의 산모를 대상으로 연구 분석하여 다음과 같은 결과를 얻었다. 1. 산모들의 연령 임신주수 임신력에서는 유의한 차이가 없었으며, 자궁경부개대 및 자궁경부 소실상태나 tocolysis score치는 치료성적과 유의한 관계를 보였다. 2. 1주일이상의 분만지연 혹은 임신37주이후의 분만을 치료성공의 기준으로 했을때 치료성공률은 32%이었으며, 평균 분만지연일은 25일이었다. 3. Ritodrine투여시 임산부의 혈압과 태아의 맥박수는 유의한 차이를 보이지 않았으나 임산부의 맥박수는 유의하게 증가하였다. 4. 치료 실패요인은 심한 모체 빈맥 감염 질출혈과 무반응 예로 구분되는데 무반응 예가 전체 실패 예의 76%로서 가장 많았다. 5. Ritochine투여로 인한 신생아의 Apgar score의 저하는 없었다. Preterm delivery accounts for 70 % of the perinatal mortality and morbidity and is therefore the principal target of obstetric dept. The beta-adrenergic agonist such as ritodrine hydrochloride (Yutopar) has demonstrated a significant prolongation in the duration of pregnancy and a decrease in immediate neonatal morbidity through several placebo-controlled studies in recent years. This study was conducted for the evaluation of the effectiveness of ritodrine hydrochloride on 25 patients selected in 104 patients admitted with preterm labor from January, 1986 to April, 1987. The results of this study were as follows: 1. There was no significant difference in clinical characteristics such as maternal age, gestational weeks, gravity and parity. But the high tocolysis score, progressed cervical dilatation and good cervical effacement were noted in the failure group. 2. The total success rate of tocolysis was 32 % and the mean time gained by ritodrine was 25 days. 3. There was no significant difference in maternal blood pressure and fetal heart rate during ritodrine infusion but the maternal tachycardia was noted. 4. The causes of treatment failure were severe maternal tachycardia, infection, vaginal bleeding and unresponsiveness. The unresponsiveness cases were 76 % of the total failure group. 5. The mean Apgar score of neonate born before 34 weeks of gestation was 4.8 (1-min)/7.3(5-min) and 7.2(1-min)/9.1(5-min) after 34 weeks gestation. There was no decrease in Apgar score from ritodrine infusion.
이영호,이봉구,이영혜,장부용,이형열,오병전,정두수 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.2
1986년 1월부터 1988년 6월까지 2년 6개월간 본원 산부인과에서 분만한 총 6275예의 분만중 미숙분만 519예에 대한 통계학적분석을 실시, 여러 위험인자에 대한 빈도를 조사하여 다음과 같은 결론을 얻었다. 1. 미숙분만율은 1986년 7.7%, 1987년 7.2%에서 1988년 10.0%로 최근 증가추세를 보이고 있다. 2. 최근 5년간 borderline preterm delivery는 54.5%를 차지하였으며, moderately preterm delivery는 32.2%, extremely preterm delivery는 13.3%를 차지하였다. 3. 미숙분만 산모의 연령분포는 35세이하 7.8%에 비해 35세이상에서 20.5%로 현저히 높았다. 4. 미숙분만 산모의 분만횟수는 분만횟수 4회이상 산모에서 28.9%로 초산부나 1회 경산부의 7.6%에 비해 현저하게 높았다. 5. 미숙분만 산모의 유산횟수는 유산경험이 없는 경우 6.6%에 비해 3회이상의 경우 17.1%로 현저히 증가되었다. 6. 산모의 교육정도와 미숙분만과 관련성은 교육기간이 길수록 적게 나타났다. 7. 미숙분만율과 최초 산전진찰시기와는 연관 관계가 없었다. 8. 분만과거력에 있어서는 과거 미숙분만 및 만기 유산력이 있는 경우 전체분만에 비해 8.2배의 높은 율을 보였으며, 과거 사산 및 주산기 영아 신생아 사망 예에서 1.9배로 높았으나, 제왕절개 수술력은 관련이 없었다. 9. 조산의 발생과 직접적 연관이 있는 원인으로는 다태임신, 선천성 태아기형, 전치태반, 태반조기박리, 자궁내 태아사망, 이상태위, 자궁경관내구무력증, 자궁기형, 양수조기파수 등이 있으며, 임신자간증 및 중증 자간전증의 경우는 의인성으로 조산을 시킨 경우도 있었으나 상당수 연관이 있었다. 10. 산모의 전신질환에는 결핵, 만성고혈압 등이 연관이 있고 심장질환, 신장질환 등에서는 별로 연관니 없었다. 11. 저 Apgar score(6) 신생아 발생율은 extremely preterm newborn에서 1분 71.2%, 5분 65.4%를 보였다. Although neonatal intensive care of the preterm newborn has improved the chances of healthy survival of infants, prematurity is still the major cause of neonatal mortality and morbidity. In order to investigate the various risk factors of preterm birth and contribute to prevention of preterm birth hereafter, we performed statistical analysis on 519 cases of preterm birth delivered at Department of Obstetrics and Gynecology, Presbyterian Medical Center from January 1986 to June 1988 per 6275 total delivery cases. The results of the study were as follows: 1. The incidence rate of preterm births was 7.7 % on 1986 and 7.2 % on 1987, and 10.0 % on 1988, increasing trends recently. 2. The rate of borderline preterm birth was 54.5 % and moderately preterm birth was 32.2 %, and extremely preterm birth was 13.3 % during 5 years, recently. 3. The rate of preterm birth to total birth by maternal age was 7.8 % in maternal age of under 35 years and 20.5 % in maternal age of over 35 years. 4. Number of preterm birth was increased as number of parity, and preterm birth rate to total birth by parity was 7.6 % in para 0.1, and 28.9 % in para above 4. 5. Number of preterm birth was increased as number of abortion, and preterm birth rate to total birth by abortion number was 6.6 % in no abortion group and 17.1 % in experienced abortion over 3 times. 6. Number of preterm birth was lesser in more 13 years education periods group than under 9 years education periods group. 7. There was no significant relationship of the preterm birth incidence rate and first antenatal care time. 8. As compared with previous obstetric history, preterm birth was 8.2 times more in cases with previous preterm birth and late abortion and 1.9 times more in cases with past still birth and postnatal death, but not related to past cesarean section. 9. Obstetric risk factors related to preterm birth was multiple pregnancy, congenital malformation, placenta previa, abruptio placenta, IUFD, abnormal presentation and IIOC, uterine anomaly, PROM and preeclampsia severe form and eclampsia. 10. High risk maternal disease was tuberculosis and chronic hypertension, but heart disease and renal discase was not related. 11. Incidence of low Apgar score($lt;6)rate was 71.2% at 1 minute and 65.4% at 5 minute on extremely preterm newborn.
자궁경암 1411 예에 대한 임상적 고찰 : 12 년간 임상 경험의 재조사 A Review of 12 Years Clinical Experience
이영호,이영혜,장부용,나창수,이형렬,오병전 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.3
1975년 1월부터 1986년 12월까지 만 12년간 자궁경암 환자에 대한 임상경험을 재 조사한 결과 아래와 같은 결론을 얻었다. 1. 발생빈도는 여성 성기에서 발생하는 악성 종양중 단연 1위였으며(28.5%), 년 평균 환자수는 117.6명이었다. 2. 자궁경암의 평균연령은 침윤성의 경우 48.5세였고 비침윤성의 경우 42.1세였다. 3. 직업별 분포는 농업, 임업, 축산업이 많았고, 지역별 분포는 전북, 충남 거주 순이었으며, 농촌 거주 환자가 도시 거주 환자보다 많았다. 4. 결혼연령 분포는 20세이하가 63.1%였으며, 기왈 출산 평균횟수는 5회였고, 한번도 유산 경험이 없었던 환자에게서의 발생빈도가 40.2%로 가장 높았다. 폐경기 이후에 환자의 47.3%가 발생하였으며 평균 폐경기연령은 47.4세였다. 5. 병리조직학적 분포를 살펴보면, 편평상피암이 대다수(93.6%)였고 선암이 6.1%를 차지하였다. 임상증상은 접촉 출혈, 자궁 점적출혈 및 자궁출혈이 가장 많았고, 자궁경의 소견은 외번이 가장 많았으며 임상기별 분포는 제II기가 가장 많았다. 6. 치료는 개별화하여 시행하였으며 자궁경 상피내암의 5년생존율은 100%였다. 침윤성 자궁경암의 경우 방사선 치료를 했을 때 5년 생존율이 제 I 기 88.0%, 제 II 기 64.1%, 제 III 기 24.1% 및 제 IV 기 33.3%였으며 광범위 수술 및 수술전후에 방사선요법으로 보조를 받았던 경우 5년 생존율은 제 I기 86.4%, 제 II기 40%였다. 광범위 수술을 시행한 경우 유병율은 12.3%였고 루공형성빈도는 1.2%였다. 7. 자궁기저암의 발생은 7예에서 볼 수 있었으며, 자궁 부분절제술 이후부터 암이 발생하기까지의 소요기간은 평균 8년이었다. 8. 임신중의 자궁경암 발생빈도는 0.06%였고, 자궁경암 환자중의 0.85%였다. 대다수 제 II기였으며(66.6%), 암이 발견된 시기는 임신 중기까지가 66.6%로 가장 많았고, 치료후 5년 생존율은 50%였다. 9. 재발은 방사선 치료시 15.0%였고, 수술을 받은 경우는 7.8&였다. 병리조직학적으로는 선암에서 더욱 높은 빈도를 보였고, 대다수 18개월내에 재발되었다. 재발의 경우 개별치료후 5년 생존율은 31.3%였다. 10. 자궁경암의 전이 장소는 폐장이 34.0%로 가장 많았다. The results of a review of 1141 cases of cervical carcinoma at Presbyterian Medical Center from January, 1975 to December, 1986 were as follows: 1. The evidence of cervical carcinoma was 11.8 % in the total number of cancer patients and 28.5 % in the female cancer patients. 2. The means number of patients per year was 117.6 cases. The mean age was 48.5 years old in invasive cervical carcinoma, and 42.1 years in intraepithelial carcinoma. 3. The lower the socioeconomic condition, the higher was the risk of cancer, and patients from rural areas showed higher risks of cancer than those from urban areas. 4. The earlier the age of marriage, the higher was the risk of cancer, but the number of deliveries and abortions was not clear. In Postmenopausal women cervical carcinoma was found in 47.3 % of the cases. 5. In the distribution by histologic type, squamous cell carcinoma was 93.6 % and adenocarcinoma was 6.7 %. The most frequent clinical symptom was postcoital or vaginal spotting and vaginal bleeding (68.0 %). In the majority of cases, the gross findings of the uterine cervix was exophytic mass (42.8 %). The distribution by clinical stages was stage I, 15.8 %; stage II, 49.7 %; stage III, 15.3; stage IV, 3.9 %. 6. The determinate five-year survival rate was as follows; a) In radiation therapy-stage I, 84.0 %; stage II, 60.8 %; stage III, 16.7 %; stage IV, 33.3 % b) In radical surgery-stage I, 86.4 %; stage II, 40.0 % 7. The incidence of carcinoma of the cervical stump was 0.49 %; the mean duration was 8 years. 8. The incidence of cervical carcinoma in pregnant woman was 0.06 % per live births and 0.85 % per cervical carcinoma. The determinate five-year survival rate was 50 %. 9. The recurrence rate in radiation therapy was 15.0 %, in radical surgery was 7.8 %. The most frequent symptom in recurrent cervical carcinoma was vaginal bleeding or spotting; an the majority of cases, the recurrence developed within 24 months (77.0 %). The determinate five-year survival rate was 31.3 %. 10. The most frequent metastatic site was the lung(34.0%).
조윤숙(YS Cho),김성진(SZ Kim),박찬수(CS Park),오병전(BJ Oh) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.6
From December 1987 until December 1993, we performed investigate clinico-pathologic studies of the ovarian tumors among Korean women. Those were admitted to department of obstetricas and hynecology, Presyterian Medical Center during the period of about 7 years who operated and confirmed with histopathological study and stastical survey were made on a series of 382 ovarian tumor patients. The ovarian tumors were classified by the W.H.O. classification. The results were followings: 1. Among 382 cases, 102 cases (26.84%) were non-neoplastic ovarian tumors, 219 cases (57.35%) were benign ovarian tumors and 55 cases (14.2%) were malignant ovarian tumors. 2. In cases of the benign ovarian tumors, cystic teratoma was most frequently revealed in 114 cases (52.05%), and among the malignant ovarian tumors, serous cyst adenocarcinoma was most frequently revealed in 18 cases (52.94%). 3. The incidence of all ovarian tumors was greatest in third decade. All the mean age of non-neoplastic cyst was 34.2 years, and that benign ovarian tumor was 34.2 years, and that malignant ovarian tumor 41.45 years. 4. The incidence of benign ovarian tumor was greatest in para 0(30.83%), and that of malignant ovarian tumor was greatest in para 2(37.7%) and para 3(18.1%). 5. The regular menstrual cycle was revealed in 62% in all ovarian tumor, and 64.3% in benign tumor and 44% in malignant tumor. 6. The lower abdominal patin was present in 40%, abdominal mass in 27.9% and abdominal distension in 8.46% of all ovarian tumors. 7. The bilaterality was 26 cases (11.8%) in benign ovarian tumor, and 19 cases (34.5%) in malignant ones, serous cyst adenocarcinoma was frequently revealed in 7 cases (40%) and 3 cases (75%) in krukenberg tumor. 8. The size of benign ovarian tumor was 6-10 cm in 98 cases (44.7%) and that of malignant ovarian tumor was 6-10 cm in 15 cases (29%). 9. The surgical treatment of benign ovarian tumor was unilateral salphingoophorectomy in 114(52%) and bilateral salphingoophorectomy and total abdomial hysterectomy in 46(21%) and unilateral salphingoophorectomy and total abdominal hysterectomy in 56(25.5%). And the surgical treatment of malignant ovarian tumor was total abdominal hysterectomy and bilateral salphingoophorectomy in 49%, total abdominal hysterectomy and bilateral salphingoophorectomy and omentectomy in 20%, total abdominal hysterectomy and unilateral salphingoophorectomy in 5.4%, besides surgical treatment, chemotherapy and radiotherapy were performed.