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김성도,한종설,송혜섭,최병익,왕성리,조필제 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12
With the changing life patterns for women in current society, increasing number of women has a tendency to postpone childbearing. Advanced maternal age has become a topic of widespread public interest, but the obstetric literature has not been as abundant in addressing this concern. This study was designed to evaluate the effects f maternal older age on reproductive performance. The 150 cases of elderly primiparas at the department of Obstetrics and Gynecology, Kangbuk Samsung Hospital from January 1990 to December 1995 were compared with 155 cases of randomly chosen young primiparas during the same period. The results were as follows; 1. There were 150 cases of elderly primiparas among the total 7649 deliveries, and incidence of the elderly primipara was 1.9%. 2. Maternal age was distributed from 35 to 44 years of age. The majority(65.3%) were in the age between 35 and 36 years. For the past 6 years, no difference was found in the distribution of year. 3. There was a significantly increased induced abortion rate and breech presentation in elderly primipara. 4. Among antenatal complications, premature rupture of membrane was the highest incidence in elderly primipara(22.7%) and control group(19.4%). The incidence of myoma was 16 cases(10.7%) in elderly primipara specifically. 5. There was a significant difference in the duration of gestational age. The preterm delivery rate was significantly increased in elderly primipara 9 cases(6.0%) compared with control group 4 cases(2.6%). 6. Concerning the modes of delivery, there was a significantly increased rate of cesarean section(78.7%) in elderly primipara. The most frequent indication for cesarean section was elderly primipara(59.3%). Other indications were cephalopelvic disproportion, breech presentation, placenta previa and failure to progress in frequency order. 7. The mean duration of labor was 8.5 hours in elderly primipara, and there was no statistical difference between the two groups. 8. There were no statistical differences between the two groups in birth weight and Apgar score. In elerly primipara, there was 1 case of intrauterine fetal death and no congenital malf- ormation. 9. Among the postpartum complications, there was a significant increase in anemia in elderly primipara 47 cases(31.3%).
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안재영,김성도,한종설,송혜섭,박정원,왕성리 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.7
1990년 1월부터 1994년 12월까지 서울 고려병원 산부인과에서 난소종양으로 개복수술을 시 행하고 수술전 혈청 CA-125치를 측정한 251예의 CA-125치의 분석결과는 다음과 같다. 1. 수술전 평균 혈청 CA-125치는 양성 난소종양, 경계성 난소종양 및 악성 난소종양에서 각각 36.6+-43.5(Mean+-SD) U/ml, 77.1+-41.2(Mean+-SD)u/ml and 567.7+-700.4(Mean+-SD)U/ml 로 나왔다. 2. 수술전 혈청 CA-125치는 양성 난소종양(36.6+-43.5(Mean+-SD) U/ml)에서보다 악성난소종 양 (567.7+-700.4(Mean+-SD)에서 경계성 난소종양 (77.1+-41.2(Mean+-SD)u/ml )에서 보다 악 성 난소종양에서 유의하게 높게 나타났다. 양성 난소종양과 경계성 난소암과의 비교에서는 유의한 차가 없었다(p$lt;0.05, mean+-SD). 3. 양성 난소종양에서 폐경전 연령군의 평균 CA-125치는 36.6U/ml이고 폐경후 연령군은 34.3U/ml로 두 연령군 사이의 CA-125치는 유의한 차이가 없었다(p$lt;0.05). 4. 양성 난소 종양군의 위양성율의 비교에서 기준치를 35U/ml와 65U/ml로 했을 경우 위양성율은 각각 31.2%와 10.5%로 기준치를 65U/ml로 한 경우가 35U/ml보다 위양성율이 유의하게 낮았다(p$lt;0.001). 5. 악성 난소종양의 임상기에 따른 CA-125 항원의 평균 농도는 1기 42.2+-23.9U/ml, 2기 67.3+-36.5U/ml, 3기 345.0+-231.5U/ml, 4기 21365.4+-1255.3U/ml로 병기가 증가할수록 CA-125 항원치는 유의하게 높게 나타났다(p$lt;0.05, mean+-SD). 6. 251예의 난소종양 환자의 평균 CA-125치는 기준치를 35U/ml로 했을때 만감도 75.8% 특이도 68.8%, 양성 예측치 35.5%, 음성 에측지 94.9%, 그리고 진단적 유효도는 69.7%이었고, 기준치 65U/ml로 했을 경우는 각각 57.6%, 89.5%, 78.6%, 93.3% 그리고 85.3%였다. 7. 양성 난소종양 중 자궁내막증에서 평균 CA-125치는 58.9+-33.5(mean+-SD)U/ml이고 하한치를 35U/ml와 65U/ml로 했을 경우 각각 55.5%, 23.2%로 가장 높은 위양성율을 나타내었다. 8. 임상병기에 따른 CA-125치의 양성율은 기준치를 35U/ml와 65U/ml로 했을 때 경계성 난소암의 경우 1기 57.1%. 42.8%, 2기 100%, 0%, 3기 100%, 100%, 4기 100%, 1000%이고 악성 난소종양에서 1기 50%, 25%, 2기 80%, 40%, 3기 100%, 100%, 4기는 100%, 100%이었다. 1기의 경우, 경계성 난소암의 경우 57.1%, 42.8%의 양성율과 악성난소종양의 경우 50%, 25%의 양성율을 보이므로 혈청 CA-125 단독 검사만으로 난소암의 조기진단은 어려울 것으로 사료된다. We evaluated serum CA-125 levels with 251 patients in ovarian tumor. The serum CA-125 levels were measured by immunoradiometric assay before lapartotomy in 218(86.8%) cases of benign ovarian tumor, 10 (4.0%) cases of low malignant ovarian tumor and 23(9.2%) cases of malignant ovarian tumor. The mean concentration of preoperative serum CA-125 antigen in benign, boderline and malignant ovarian tumor were 36.6+-43.5(Mean+-SD) U/ml, 77.1+-41.2(Mean+-SD)u/ml and 567.7+-700.4(Mean+-SD)U/ml, respectively. These findings suggest that elavated serum CA-125 levels help differential diagnosis of ovarian malignancy from benign and borderline ovarian tumor, but less relateive differential diagnosis of boderline malignant tumor from benign ovarian tumor(p$lt;0.05). Among 218 patients with benign ovarian tumor, CA-125 levels above 35U.ml, and 65U/ml were detected in 68(31.2%) and 23(10.5%) cases of the patients respectively. Seven of 10(70%) cases of boderline ovarian tumor were associated with CA-125 levels above 35 U/ml and 5 of 10(50%) cases had levels that exceeded 65U/ml. Eighteen of 23(78.3%) cases of malignant ovarian tumors were associated with CA-125 levels above 35U/ml and 14 of 23(60.9%) cases had levels that exceeded 65U/ml. In 251 patients with benign, boderline and malignant ovarian tumors, the positive rates of preperative serum CA-125 levels were 75.8% sensitively, 68.8% specificity, 35.5% positive predictive values, 94.4% negative predictive value, and 69.7% diagnostic efficiency for a 35Uml cut-off and 57.6%, 89.5%, 78.6%, 93.3% and 85.3% resectively for a 65U/ml cut-off. This serum CA-125 levels seem to provide less information for early diagnosis of both boderline malignant and malignant ovarian tumors due to highly false negativity of early stage in boderline malignant and malignant ovarian tumor. The mean concentration of preoperative serum CA-125 antigen of stage I, II, III, IV in malignant ovarian tumor were 42.2+-23.9(Mean +-SD)U/ml, 67.3+-36.5(Mean+-SD)U/ML, 345.0+-231.5(Mean+-SD)U/ml and 2136.4+-1255.3(mean+-SD), respectively. Preoperative CA-125 level have good correlation with clinical stage of ovarian maligancy. Accurate diagnosis of the malignant ovarian tumors may be difficult becase endometriosis(58.9+-33.5U/ml) and other benign ovarina tumors showed high concentration and false positive rate.
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