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외음회음 근막피부피판을 이용한 선천성 질결여증의 재건례
김미선,김철한,이용석,강상규,탁민성,Kim, Mi-Sun,Kim, Chul-Han,Lee, Yong-Sek,Kang, Sang-Gue,Tark, Min-Sung 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6
Purpose: Congenital absence of the vagina is a rare case. It occurs as a result of Mullerian duct aplasia or complete androgen insensitivity syndrome. The reconstructive modality includes skin graft, use of intestine and various methods of flap. We report a patient who underwent vulvoperineal fasciocutaneous flap to reconstruct congenital absence of the vagina, while the external genitalia and ovaries are normal. Methods: A 26-year-old woman presented with vaginal agenesis. Under general anesthesia, a U-shaped incision was made between the urethral meatus and the anus. The new vaginal pocket was created up to the level of the peritoneal reflection between the urinary structures and the rectum. Next, the vulvoperineal fasciocutaneous flaps were designed in a rectangular fashion. Flap elevation was begun at the lateral margin which the adductor longus fascia was incised and elevated, and the superficial perineal neurovascular pedicle was invested by the fascial layer. The medial border was then elevated. A subcutaneous tunnel was created beneath the inferior of the labia to rotate the flaps. The left vulvoperineal flap was rotated counterclockwise and the right was rotated clockwise. The neovaginal pouch was formed by approximating the medial and lateral borders. The tubed neovagina was then transposed into the cavity. Results: In 3 weeks, the vaginal canal remained supple After 6 weeks, the physical examination showed normalappearing labia majora and perineum with an adequate vaginal depth. A year after the operation, the patient had a 7 cm vagina of sufficient width with no evidence of contractures nor fibrous scar formation. The patient was sexually active without difficulty. Conclusion: Although many methods were described for reconstruction of vaginal absence, there is not a method yet to be approved as a perfect solution. We used the vulvoperineal fasciocutaneous flap to reconstruct a neovagina. This method had a following merits: a single-stage procedure, excellent flap reliability, the potential for normal function, minimal donor site morbidity and no need for subsequent dilatation, stents, or obturators. We thought that this operation has a good anatomic and functional results for reconstruction of the vagina.
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ASCUS나 LSIL이 보고된 폐경여성에서 고등급 자궁경부병변을 예측하는데 있어 HPV viral Load 값의 의의
이해남 ( Hae Nam Lee ),정인철 ( In Cheul Jeung ),이용석 ( Yong Sek Lee ),박은경 ( Eun Kyung Park ),김찬주 ( Chan Joo Kim ),박종섭 ( Jong Sup Park ),남궁성은 ( Sung Eun Namkoong ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11
목적: Unsatisfactory colposcopy 소견이면서 ASCUS나 LSIL이 보고된 폐경여성에서 고등급 자궁경부병변을 예측하는데 HPV viral load 값이 도움이 되는지 평가하였다. 방법: HPV 검사가 양성이면서 ASCUS나 LSIL이 보고된 폐경여성들 중 진단적 conization을 시행한 54명을 분석하였다. HPV검사는 hybrid capture II을 이용하였다. 자궁경부의 조직학적 결과에 따라 저위험군 (만성자궁경부염, CIN I)과 고위험군 (≥CIN II)으로 나누었다. Viral load값에 따라 100 RLU/PC 미만인 군과 100 RLU/PC 이상인 군으로 나누었고 각 군의 자궁경부 병변들을 서로 비교하였다. 결과: 만성 자궁경부염이 30명, CIN I이 9명, CIN II가 3명, CIN III가 12명이었다. Viral load가 100 RLU/PC 미만인 경우에는 CIN II 이상이 4명 있었으나 100 RLU/PC 이상인 경우에는 11명으로 유의하게 많았으며 (P=0.013) viral load가 100 RLU/PC 이상일 경우 100 RLU/PC 미만일 경우에 비해 ≥CIN II을 가질 상대위험도는 2.043 (95% CI, 1.216~3.432)으로 유의하게 높았다. 결론: Unsatisfactory colposcopy 소견이면서 ASCUS나 LSIL이 보고된 폐경여성에서 HPV viral load값이 높을 경우 ≥CIN II을 가질 위험이 높다. Objective: To evaluate whether determination of the Human Papilloma Virus (HPV) viral load is helpful to predict the presence of high-grade cervical intraepithelial neoplasia (CIN) that requires aggressive treatment in menopausal women who have presented with an unsatisfactory colposcopic finding and ASCUS or LSIL. Methods: In menopausal women with ASCUS or LSIL and with who were positive for HPV, 54 women had diagnostic conization were analyzed retrospectively. We used the Hybrid Capture II method. We classified women in a low-risk group (chronic cervicitis, CIN I) and a high-risk group (≥CIN II) according to the pathological results of conization. We also classified patients into the HPV viral load <100 RLU/PC group and ≥100 RLU/PC group. We analyzed the relationship between the pathological results of conization and viral load. Results: For the conization, 30 women had chronic cervicitis, nine women had CIN I, three women had CIN II and 12 women had CIN III. In the low Hybrid Capture titer-group (<100 RLU/PC), four women had high risk ≥CIN II pathology but in the high Hybrid Capture titer-group (≥100 RLU/PC), 11 women had high risk pathology this finding was statistically significant (P=0.013). Compared to the low Hybrid Capture titer group, the relative risk of high grade CIN (≥CIN II) in the high Hybrid Capture titer group was 2.043 (95% CI, 1.216~3.432). Conclusions: For menopausal women with an unsatisfactory colposcopic finding and also have ASCUS or LSIL women with high HPV viral load might have tendency of ≥CIN II pathology.
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동서연 ( Seo Yun Tong ),이용석 ( Yong Sek Lee ),박종섭 ( Jong Sup Park ),이준모 ( Jun Mo Lee ),남궁성은 ( Seung Eun Namkoong ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.9
목적: 부인과 영역에서 동시에 발생하는 원발암에 대한 임상적 분석을 통해 발생 빈도, 임상적 특징 및 예후를 알아보고자 한다. 연구 방법: 2000년 2월부터 2005년 1월까지 부인암을 진단 받은 환자 중 다발성 일차암으로 진단된 환자를 대상으로 임상병리적 특징, 치료 및 치료 후 결과에 대해 후향적으로 고찰하였다. 결과: 같은 기간에 부인암을 진단 받은 환자는 모두 3164명으로 그 중 20명이 동시성 일차암으로 진단되어 0.63%의 빈도를 나타내었다. 이중 생식기에 다발성 종양은 13명이었고 가장 많은 동시성 일차암은 자궁내막암과 난소암으로 20명 중 8명이었다 (40%). 자궁내막암과 난소암이 동시에 발생한 경우는 평균연령이 45.2세로 각각 종양이 발생한 경우보다 비교적 빠른 나이에 발생하였고, 조직학적으로는 자궁내막선암과 난소의 자궁내막양 선암이 동반된 경우가 5예로 빈도가 높았다. 수술 후 추적관찰기간 동안 2명의 환자가 사망하였고, 평균 생존 기간은 57개월 (SE 10.0, 95% Confidence interval 37-77)이었다. 결론: 부인암과 동시에 발생하는 원발암은 비교적 드문 질환이다. 그 중 자궁내막암과 난소암의 빈도가 가장 높고 일반적으로 단일암보다 젊은 나이에 발생하며, 수술과 보조적 치료로 비교적 좋은 예후를 기대할 수 있다. Objective: A histopathologic review of synchronous primary neoplasms of the female reproductive tract was presented and the possible correlation among discrete tumor subsets, natural history, and survival was evaluated. Methods: Between 2000 and 2005, 20 patients with synchronous primary cancers of the gynecologic malignancy were identified. Clinical and pathologic informations were obtained from medical records. Kaplan-Meier survival analysis was performed. Results: The patients with Synchronous primary malignancies constituted 0.63% of all genital malignancies. The most frequently observed synchronous neoplasms were those of the ovary with the endometrium (40%). The mean age of patient with synchronous ovarian and endometrial cancer was 45.2 years. 8 patients underwent the hysterectomy with bilateral salpingo-oophorectomy and adjuvant therapy. The mean survival is 57 months (SE 10.0, 95% Confidence interval 37-77). Conclusion: Synchronous ovarian and endometrial cancers were detected in relatively early age and the prognosis was favorable.
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