Evaluation of Colposcopic Accuracy for diagnosis of the early cervical cancer

오병찬(BC Oh),조윤희(YH Cho),김종덕(JD Kim) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.5

1. 질확대경소견은 만족군 182예중 정상소견 123예, 비정상변환대 44예, 침윤암소견 15예이 었으며 불만족군은 6예였다. 2. 만족군에서 세포진검사와 조준생검과의 일치율은 80.2% 이었으며, 세포진검사와 위음성 율과 위양성율은 각각 14.3%, 5.5%이었다. 3. 만족군에서 질확대경에 의한 추정진단과 조준생검과의 일치율은 81.3%이었으며, one pathological grade내에서 일치된 경우는 99.4%였다. 4. 만족군에서 질확대경에 의한 조존생검과 최종수술후 조직진단과의 일치율은 71.9%이었으 며 one pathological grade내에서 일치된 경우는 90.6%였다. Colposcopic examination is an important diagnosis technique in evaluating abnormal cytologic smears and pathological alterations of the cervix and vagina. But its accuracy depends upon criteria determining its limitations and examiners experience . Most important limitation of colposcopy is incomplete visualization of transformation zone extending into the endocervical canal. To solve this dilemma, some reportes incorporate endocervical curettage or cervical conization into the colposcopic examination. The purpose of this study was to evaluated the diagnostic value of colposcopic findings, to compare these finding with the histology of colposcopically directed biopsy and to determine the accuracy of cytologic smear and colposcopically directed biopsy when performed without the use of endocervical curettage in the patients with satisfactory colposcopic findings. From January .1 1986 to June .30 1987 the colposcopic examination was undertaken in 188 patients grouping them into 142 negative cytologic smears with grossly suspicious areas and 46 positive cytologic smears excluding macroscopically visible carcinoma of the cervix. The results were as follows; 1. Colposcopic findeg revealed normal in 123 cases atypical transformation zone in 44 ones, frank invasive cancer in 15 ones and unsatisfactory in 6 ones. 2. Accuracy of cytology in the satisfactory group was 80.2% and its false negative and positive rate were 14.3% , 5.5% respectively when compared to the histology of colposcopically directed biopsy. 3. Accuracy of colposcopic impression in the satisfactory group was 81.3% when compared to the histology of colposcopically directed biopsy. 4. Accuracy of colopscopically directed biopsy in the satisfactory group was 71.9% when compared to the histology of final surgical specimen and its underestimated rate was 9.4% when compared within pathologic grade difference.

습관성 유산 환자에 있어서의 Toxoplasma 항체가

김생기(SK Kim),정채득(CD Jeong),오병찬(BC Oh),김종덕(JD Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.6

A prospective study of 110 obstetric cases was done to find out the role of toxo- plasmosis in abortion. The subjects comprised 15 habitual abortion, 35 sporadic abortions and 60 normal pregnancy cases were investigated for toxoplasmosis by dye test and by mouse inoculation with gestational materials. In no case, could Toxoplasma gondii be isolated from the pregnant endometrium by inoculation. The dye test was positive in 80 per cent of habitual abortion and 62.7 per cent of spo- radic abortion respectively. In normal pregnancy as the control postives result were pregnancy and abortion were significnat particularly in habitual abortion. These findings suggest that toxoplasma may prove an important etiological factor for spontaneous abortion.

자궁경부암 환자의 근치수술후 치료성과

정병규(BK Jung),박종덕(JD Park),오병찬(BC Oh),김종덕(JD Kim) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.4

전북대학병원 산부인과에서 1975년 1월부터 1987년 6월까지 만 12년 6개월간 자궁경암으로 수술받은 135예에 대하여 주로 수술후 합병증과 치료성적을 조사분석하여 다음과 같은 결론 은 얻었다. 1. 연도별 수술환자수는 1975년부터 1976년까지의 연평균 3.5예에서 1985년부터 1987년까지 의 26예로 현저한 증가를 보였다. 2. 연령별분포는 41-50세군에서 전체의 40.7%의 분포를 보여 가장 높은 발생빈도를 보였다. 초혼연령별 분포는 19-21세군에서 전체의 35.8%의 분포를 보여 가장 많았다. 3. 분만과의 관계는 분만회수 3-4회의 경우에 가장 높은 빈도를 보였다. 4. 자궁경암의 임상증상으로는 접촉성 출혈을 비롯한 비정상 성기출혈이 63.7%로 가장 많았 고 다음은 대하증으로 23%였다. 5. 임상기별 분포는 제 IB기가 75예(55.6%), 제 IIA기 27예(20.0%),제 0기 18예(13.3%), 제 IA기 10예(7.4%), 제 IIB기 5예(3.7%)순이었다. 6. 병리조직학적 분류는 편평상피암이 94.8%로 가장 많앗고, 이중에서 상피내암이 14.1% 미 세침윤암 7.0%, 침윤암이 78.9%였다. 7.침윤성 편평상피암중에서 세포형태에 따른 분류는 대형세포비각질화암이 62.9%로 가장 많 았고, 대형세포각질화암이 34.3%, 소형세포비각질화암이 2.8%였따. 8. 자궁경암에 병발된 질환은 빈혈이 12예(8.9%)로 가장 많았고, 자궁근종 11예(8.2%) 고혈압 및 폐질환이 각각 3예(2.2%)순이었다. 9. 근치자궁적출술을 시행한 111예에서 수술후 합병증의 빈도는 뇨로감염이 36예(32.4%)로 가장 많앗고 하지 또는 외음부부종 8예(7.2%) 수술창 감염 및 골반내 혈종이 각각 7예(6.3%) 순이었으며 수술로 인한 사망은 없었다. 10. 근치자궁적출술을 시행한 예에서 임파선전이 빈도는 제 I기 및 제II기에서 각각 13.8%, 16.1%의 전이율을 보였다. 1. The annual incindence of patients treated with surgery was increased gradually. 2. The age distribution was most commonly between 41 and 50 years. The age distribution of first marriage was most commonly between 18 and 21 years. 3. The most common parity was 3-4times 4. The most frequency clinical symptoms of cervical cancers were contact bleeding (25.2%) and vaginal spotting (24.4%). 5. Distribution of the patients by the clinical stages was as follows; stage 0; 18cases (13.3%), stage IA;10cases (7.4%), stage IB;75cases (55.6%) stage IIA ; 27cases (20.0%). stage IIB; 5cases (3.7%). 6. The results of histopathologic types were distributed as follows; squamous cell carcinoma was 94.8% adenocarcinoma was 5.2% and adenocarcinomous carcinoma was 0%. 7. The histologic subtype of invasive squamous cell carcinoma (70cases) were as follows; Large cell non-keratinizing type was 62.9% large cell keratinizing type was 34.3% and small cell non-keratinizing type was 2.8%. 8. The most frequency medical conditin in preoperative patients was anemia(8.9%). 9. The most common complications after radical hysterectomy was urinary tract infection(32.4%) 10. The incindence of lymph node metastasis was 13.8% in stage I and 16.1% in stage II, The overall incindence of regional node metastasis was 14.4%. 11. The result of 5year survival rate in confirmed patients by follow-up was 100% in stage 0. 100% in stage IA, 76.5% in stage IB and 57.1% in stage IIA. Overall 5 year survival rate was 79.4%. 12. The incindence of recurrence was 7.4% and recurrent sites were viginal stump, rectum, pelvic wall and abdominal cavity.

Mehotrexate 국소요법으로 치유한 자궁경관임신

김난경(NK Kim),정영주(YJ Jung),류철희(CH Rhyu),오병찬(BC Oh) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.4

저자들은 자궁경관임신으로 진단받고 태아 심박동이 확인된 환자에서 MTX 전신요법을 사용 하여 실패한 후 질초음파하에서 양막강내 MTX 직접 주십을 시도하여 성공하였다. 임신능력을 유지하기 위해 자궁보존을 목적으로 하는 경우, 초기에 진단되는 자궁경관 임신 에서 치료방법으로 양막내 MTX 직접 투여를 시도해 볼가치가 있다고 사료되는 바이다. The possibility of fertility loss is nerver greater than with a cervical pregnancy, the rarest type of ectopic gestation. Methotrexate has been utilized recently for the successful management of tubal, interstitial and cervical ectopic gestations. We report a case in which a viable cervical pregnancy was diagnosed in the first trimester and in which the patient was successfully treated with intraamniotic methotrexate administraion guided by transvaginal ultrasonography without surgery after failure fo systemic methotrexate management.

원격전이된 재발성 난소 윤상소관형 성기삭 종양 (SCTAT) 의 화학요법 경험 1 예

오병찬,김종덕,진소자,김관식 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

저자들은 18세 터너증후군으로 확인된 환자에서 발생한 난소 SCTAT의 보존적 수술을 시행한 후 6년 8개월 만에 두경부, 골반부, 복부림프절의 재발 및 전이가 확인되어 BEP 병합 화학요법을 3회 시행하였다. 환자는 마지막 추적검사에서 부분적 관해를 보였으며 치료 중단 후 만 1 년이 넘은 현재에도 특이한 증상 및 불편감 없이 생활하고 있다. 이에 임상적인 문헌 고찰과 함께 보고하는 바이다. Sex cord tumor with annular tubules (SCTAT) is an unusual ovarian neoplasm. The standard treatment for recurrent SCTAT was not established. This tumor was considered as a tumor with low-grade malignancy. A case of recurrent ovarian sex cord tumor with annular tubules in a 24-year old female with Turner`s syndrome was reported. The recurrence and metastasis were diagnosed accidentally through the operation of a palpable neck mass in the department of ENT in our hospital. Retroperitoneal lymphatic metastasis was thought to an important pathway of spread. Persistent amenorrhea, pelvic mass, and para-aortic masses were important clinical features. The patient was treated with combination chemotherapy of three cycles. The regimen consisted of bleomycin, etoposide, and cisplatin.

질확대경검사시 자궁경관소파술의 진단적 가치

오병찬,김종덕,김경옥,정병규,이동복 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.1

1.세포진검사의 정확도는 조준생검결과와 비교하여 64.8 %이었으며, 위음성율과 위양성율은 각각 23.9%, 11.3 &였다. 2. 질확대경에 의한 추정진단의 정확도는 조준생검결과와 비교하여 73.2 %이었으며, underestimated rate는 16.9 %였다. 3. 질확대경에 의한 조준생검결과와 최종 병리조직 진단과의 일치율은 77.8 %, one pathologic degree내에서의 일치율은 96.3 %이었으며, 조준생검의 underestimated rate는 14.8 %였다. 4. 자궁경관소파술 병용군에서 경관내에 이형상피증이상의 양성율은 19.4 %(6/31)이었으며, 연령분포는 6명중 5명이 40대이었다. 5. 질확대경검사시 자궁경관소파술 비병용군과 병용군간에 치료전침윤암의 오진율은 각각 3.1 %(1/32), 4.5 %(1/22)로서 비슷하였으나, 병용군에서 침윤암 13명중 2명은 자궁경관소파술에 의해 진단되었다. With the use of colposcopy to evaluate cervical lesions, the management of patients with abnormal Papanicolaou smears has become more individualized and developed. But colposcopic accuracy depends on criteria determining its limitations and examiners experience. Most important limitation of colposcopy is incomplete visualization of transformation zone extending into the endocervical canal. To improve the diagnostic accuracy of colposcopy before management, some reporters have suggested that endocervical curettage be an integral part of colposcopic examination. This suggestion has not been accepted by all authors. This study was undertaken to compare cytologic diagnosis and colposcopic impression with the histology of colposcopically directed biopsy, to determine the accuracy of colposcopy-directed biopsy, and to demonstrate whether the addition of endocervical curettage to colposcopy-directed biopsy can eliminate further diagnostic evaluation(conization) in the management of patients with satisfactory colposcopic findings. From Jan. 1, 1986 to Sep. 30, 1988, the colposcopic examination was undertaken in 71 patients with abnormal cytologic smears, excluding grossly visible carcinoma of the cervix. The results were as follows: 1. Accuracy of cytology was 64.8% and its false negative and positive rate were 23.9%, 11.3% respectively when compared to the histology of colposcopically directed biopsy. 2. Accuracy of colposcopic impression was 73.2% and its underestimated rate was 16.9% when compared to the histology of colposcopy-directed biopsy. 3. Accuracy of colposcopically directed biopsy was 77.8% and its underestimated rate was 14.8% when compared to the histology of final surgical specimen. 4. An endocervical curettage was obtained in 31 patients and was positive in 19.4% (6/31) of those sampled, including two patients with no lesion found on directed biopsy specimen. 5. There were two cases in which an invasive cancer was missed prior to therapy, one in the non-ECC group of 32 patients (incidence 3.1%), the other ECC group of 22 patients(incidence 4.5%) when comparedto the final pathologic diagnosis.

Candida성 질염에 대한 Fluconazole의 임상적 치료 효과

오병찬,안진섭,김종덕,황수경,이희섭,차경연,양재이 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.11

저자 등은 1991년 2월 1일부터 9월 30일까지 대하, 음부소양증 및 작열감을 주소로 전북대학교병원 산부인과 외래에 내원한 환자중 질분비물 직접도말검사와 배양검사에 의해 candida가 확인된 비임신 여성 33명을 대상으로 fluconazole 1회 경구요법을 사용하여 다음과 같은 결과를 얻었다. 1. 환자의 연령분포는 28∼60세이며, 평균연령은 37.7세였고 분만횟수는 2회 군이 21례로 63.6%를 차지했다. 2. 치료후 자각증상의 소실은 작열감이 100%, 대하증이 81.5% 음부소양증이 76.9%였으며 질경소견상의 호전은 외음 및 질의 표피박라기 91.7%, 홍반이 85.0%, 분비물이 73.3%였다. 3. 진균성 질염의 원인균은 candida albicans가 29례로 88%차지하였다. 4. Sabouraud dextrose배지를 이용한 배양법에 의해 치료판정한 결과 치료 1주후의 추적검사에서 90.0%의 치료성적을 보였으며 4주후의 추적검사에서 93.1%의 치료 지속효과를 나타냈다. 5. 약제의 부작용은 자각적 증상이나 검사학적인 면에서 발견할 수 없었다. A clinical study about effectiveness of single dose Fluconazole (Diflucan) therapy in vaginal candidiasis has been carried out in 33 patients who visited Department of Obstetrics and Gynecology, Chonbuk National University Hospital form February 1st, 1991 to September 30th, 1991. Ages ranged from 28 years to 60 years with a mean of 37.7 years and the mean height was 157.1 cm and the mean body weight was 53.0kg. The majority of contanception methods (69.7%) were IUD and surgically sterilized methods. The most offending organism was Candida albicans (88%). The subjective symptoms such as discharge, pruritus, burning were ameliorated after treatment in 81.5%, 76.9% and 100%, respectively. The clinical signs such as erythema, excoriation, erosion and discharge were ameliorated after treatment in 85.0%, 91.7%, 71.4% and 73.3%, respectively. Ninety-one percent(30/33) of patients treated with the single dose were found to be cured at the 1-week follow-up, and this persisted in 93.1%(27/29) of patients to the 4-week follow up. There were no undesirable side effects in all patients during and after treatment. Fluconzole may become the orally active antifungal agents capable of treating vaginal candidiasis with single dose therapy.

자궁경부 원추절제술의 진단적 가치

오병찬,안진섭,하정미,김관식 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.5

1981년 1월부터 1991년 12월까지 만 11년간 전북대학병원 산부인과에 입원하여 원추생검 을 시행한 125례의 환자를 대상으로 질확대경을 이용하지 않은 전반기(47례)와 질확대경을 이용한 후반기(78례)로 나누어 자궁경부 원추생검술의 진단적 가치를 비교분석하여 다음과 같은 결과를 얻었다. 1. 4분천자생검과 원추생검의 일치율은 68.1%였고, 4분천자생검이 과소평가된 율은 31.9%였다. 2. 질확대경하 조준생검과 원추생검의 일치율은 70.6%였고, 조순생검이 과소평가된 율은 29.4%로서 4분천자새검의 결과와 큰 차이를 보이지 않았다. 3. 질확대경을 이용하지 않은 전반기에 원추생검 후 자궁적출술을 시행한 31례중 병소가 잔 류한 경우는 20례(64.5%)로 병변의 진행정도에 따라 잔류빈도는 이형중에서 50%(10/20), 상피 내암에서 75%(3/4), 미세침윤암에서 100%(2/2), 침윤암에서 100%(5/5)로 병변이 진행될수록 병 소의 잔류 가능성이 높은 것으로 나타났으며, 잔류병소가 원추생검 결과보다 더 진행된 병리 조직을 보인 경우는 이형중에서 1례(상피내암), 미세침윤암에서 1례(침윤암)를 보였다. 4. 질확대경을 이용한 후반기에 원추생검후 자궁적출술을 시행한 55례중 병소가 잔류한 경우 는 22례(40%)로 전반기에 비하여 잔류빈도가 현저히 감소하였으며, 병변의 진행정도에 따라 잔류빈도는 이형증에서 43%(9/21), 상패내암에서 68%(17/25), 미세침윤암에서 50%(2/4), 침윤암 에서 80%(4/5)로 전반기와 같이 병변이 진행될수록 병소의 잔류빈도가 높게 나타났으나, 잔류 병소가 원추생검 결과 보다 더 진행된 경우는 없었다. 결론적으로 질확대경의 경험이 적은 의료기관에서는 조준생검시 과소평가율이 높기 때문에, 특히 상피내암 등 CIN-III 환자에서는 침윤암을 배제하기 위하여 진단적 원추생검이 필요할 것으로 사료된다. 또 질확대경하 원추생검시에도 병소의 잔류빈도가 상당히 높기 때문에 원 추생검만으로 치료를 끝낼 경우에는 철저한 추적관리가 강조된다. The past several years have seen the general adoption of colposcopy as part of the routine evaluation of abnormal cervical cytology. The indications for cone biopsy are, therefore, more limited now than in the past. This procedure is still mandatory to evaluate CIN in women with a transformation zone that is not completely visible coloposcopically. It is also indicated for extensive lesions of CIS and in situations in which the severity of the cytology is not explained by colposcopic examination and biopsy. In the face of the changing role of cone biopsy, we have reviewed the clinical material to evaluate the efficacy of conization. Histopathologic findings of 125 conization cases were compared to the cytology, multiple punch biopsy, colpodirected punch biopsy and postcone hysterectomy findings. Forty seven patients had been managed by multiple punch biopsy and 78 patients, by colpodirected punch biopsy before conization from January, 1981 to December, 1991 at the Gynecologic Department of Chonbuk University Hospital. The results were summarized as follows: 1. The rate of agreement and underdiagnosis of 4-quadrant punch biopsy were 65.9%, 34.1% and those of colpodirected punch biopsy were 70.6%, 29.4% respectively to the result of conization. 2. The frequency of residual lesions in the postcone hysterectomy specimens was 64.5% in precolposcopic group, 40% in postcolposcopic group, and 48.9% in total. 3. Overall complication of conization was 9.6%, of which 4.8% was bleeding requiring resuture or operation. 4. According to conization-hysterectomy time interval, frequency of postoperative morbidity was 46.2% between 3 days and 6 weeks, 10.3% before 48 hours and after 6 weeks.

골반종괴 환자에서 수술전 CA125 검사의 임상적 가치

오병찬,안진섭,김종덕,김승일,엄철 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.3

저자들은 1990년 7월부터 1991년 7월까지 만 13개월간 전북대학교병원 산부인과에서 경험한 143예의 골반종괴 환자를 대상으로 방사면역법을 이용한 수술전 혈청내에 존재하는 CA125값을 측정하여 다음과 같은 결과를 얻었다. 1. CA125값의 평균치는 양성종양군에서 59.0U/ml, 악성종양군에서는 186.7U/ml였다. 2. CA125치가 35U/ml이상인 경우는 양성군에서 29.3%, 악성군에서 70.0%로 나타났고, 65U/ml이상인 경우는 양성군에서 13.5%, 악성군에서는 50.0%였다. 3. 양성종양군에서 조직학적 형태에 따른 양성율의 빈도는 자궁내막증(100%), 난소섬유종75.0%), 자궁선근종(62.5%), 자궁근종(24.2%), 양성난소낭종(23.5%), 유피낭종(0.1%) 순으로 나타났다. 악성종양군에서 조직학적 형태에 따른 양성율의 빈도는 장액성 난소암 3예중 모두에서, 점액성 난소암 5예중 3예에서, 미분화세포종 1예에서 양성으로 나타났고 자궁육종 1예에서는 양성을 보이지 않았다. 4. 수술전 CA125의 민감도와 특이도는 각각 70%, 71%였다. 5. 악성종양을 반영하는 수술전 CA125의 양성예견율은 15%였으며, 양성질환을 나타내는 음성예견율은 97%였다. 6. 연령에 따른 CA125의 민감도, 특이도 및 양성예견율의 차이는 조사대상이 적은 관계로 의의있는 결과를 얻지 못했다. 이상의 결과로 보아 수술전 CA125측정이 질환의 양성 및 악성상태를 예견하는 데는 한계가 있지만 연령이 폐경이후나 부인암에 대한 종양표지물질이 의의있게 증가된 고위험 환자에서는 일차수술시 암수술이 가능하고 경험이 축적된 상급병원으로 후송조치함으로써 2차 수술에 의한 이환율과 경비를 줄일 수 있을 것으로 사료된다. CA 125 is an antigenic determinant expressed by more than 80% epithelial ovarian cancer that may be precisely measured in serum with radioimmunometric assay. As a marker of known ovarian carcinoma, CA125 assay has been widely and successfully used to monitor progression or regression of disease. Various other malignancies and benign diseases have also been associated with elevated levels of CA125. Recent efforts of refine the use of preoperative serum CA125 have focused on patients more likely to have a gynecologic malignancy, that is, those with a pelvic mass. Our present study was undertaken to define further the usefulness of preoperative CA125 assay as a diagnostic adjunct in differentiating benign from malignant pelvic masses. The results were as follows ; 1. The mean value of preoperative serum CA125 levels was 59.0 U/ml in the benign masses, and 186.7 U/ml in the malignant masses. 2. Benign pelvic masses had CA125 levels 35 U/ml in 29.3% of cases but 65 U/ml in only 13.5%, pelvic malignancies had CA125 levels 35 U/min in 70% and 65 U/ml in 50%. 3. The sensitivity and specificity of preoperative CA125 assay were 70, 71%, respectively. 4. The positive predictive value of an elevated preoperative CA125 indicating malignancy was 15%, the negative predictive value of a normal preoperative CA 125 reflecting benign disease was 97%.

자궁부속기 질환의 치료에 있어서 골반경 수술과 개복수술의 비교연구

오병찬,김종덕,류철희,김관식 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

목적: 양성종양의 불필요한 개복수술과 악성종양의 부적절한 골반경수술을 피하고 자궁부속기종양 골반경수술의 비율을 높이기 위함 연구방법: 정해진 개복수술의 지침에 따라 자궁부속기 종괴의 개복 또는 골반경수술을 시행하고 수술방법, 수술시간, 재원기간, 합병증, 개복수술 요인과 개복수술의 적합성 여부에 대한 수술자 의견 등이 분석됨. 결과: 18개월간 자궁부속기 종괴로 개복수술[159명]과 골반경수술[129명]이 시행됨. 개복수술/골반경수술 비율은 전체적으로 55.2%/44.8%, 비종양성 종괴는 44.5%/55.5%, 양성종양은 58.1%/41.9%, 경계성종양 100.0%/0.0%, 악성종양 91.7%/8.3%임. 주요 개복이유로 비종양성 자궁부속기 종괴는 복막염 또는 혈복강을 의심하는 증상 징후와 함게 불안정한 생체활력징후[32.1%]와 중증 골반강내 유착의 강력한 의심이나 확인[24.5%], 양성종양은 세밀한 낭종박피술이 필요한 직경 6cm 이상의 종괴[26.7%]와 중증 골반강내 유착의 강력한 의심이나 확인 [18.6%]임. 난소암 골반경수술은 1례[0.78%]임. 수술자는 개복수술의 28.9%가 골반경수술에 적합했을 것으로 판단함. 결론: 자궁부속기 종양에 있어 골반경수술이 개복수술보다 더 나은 방법이며 유착을 의심하는 환자나 의심스런 종괴에 대해서도 신중한 골반경수술의 재고가 필요하리라 사료됨. 또 한편 골반경수술 적용을 위해 더 주의깊은 수술 전, 수술 중 검사가 이뤄져야 할 것임. Objective: To increase proportion of pelviscopic surgery, and besides, avoid unnecessary laparotomy for benignity and pelviscopic surgery of malignancy in adnexal masses. Methods: Adnexal masses were managed by laparotomy or laparoscopy under the stated guideline. We analyzed data of the surgical procedure, operative time, hospital stay, and complication, guideline applied and the operator`s opinion on the adequacy of each laparotomy. Results: Over an 18-month period, laparotomy [n=159] or pelviscopy [n=129] were performed. Mean operative time and hospital stay in the pelviscopy group were shorter than those in the laparotomy group. The proportion of laparotomy/pelviscopy were 55.2%/44.8% in overall, 44.5%/55.5% in non-neoplastic tumors, 58.1%/41.9% in benign neoplasm, 100.0%/0.0% in borderline tumor and 91.7%/8.3% in malignancy. The main reasons of laparotomies were unstable vital sign with some symptoms and signs of generalized peritonitis or hemoperitoneum[32.1%] and suspected severe pelvic or abdominal adhesion [24.5%] in non-neoplastic tumor. The patients of benign neoplasms had laparotomies chiefly due to elaborate enucleation in the cyst of diameter 6cm for fertility[26.7%] and suspected severe pelvic or abdominal adhesion [18.6%]. Pelviscopic surgery of ovarian cancer was 1 case [0.78%]. Operator was of opinion that the rate of inadequacy in laparotomies was 28.9% in overall. Conclusion: Pelviscopic surgery is superior to laparotomy in the management of adnexal masses and may be considered prudently in patients of pelvic adhesion suspected and in adnexal tumors those can`t confirm as benignancy. In addition to preoperative evaluations, operative findigs and frozen biopsy should be obtained more carefully for pelviscopy of adnexal tumors.