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원발성 무월경과 재발성 자궁내막증을 초래한, 자궁경부와 분리되어 맹관을 형성한 자궁체부의 자궁성형술
안세영 ( Se Young Ahn ),김현정 ( Hyun Jung Kim ),신현미 ( Hyun Mi Shin ),박호정 ( Ho Jeong Pak ),송재연 ( Jae Yen Song ),오순남 ( Soon Nam Oh ),정재은 ( Jae Eun Chung ),임용택 ( Young Taik Lim ),김장흡 ( Jang Heub Kim ),김진홍 ( J 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.9
Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women`s obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.
폐경 전과 폐경 후 비정상출혈 환자의 진단에 있어 경질초음파 검사의 유용성
임시연 ( Si Yeon Lim ),조현희 ( Hyun Hee Jo ),황성진 ( Sung Jin Hwang ),김미란 ( Mee Ran Kim ),권동진 ( Dong Jin Kwon ),김장흡 ( Jang Heub Kim ),임용택 ( Yong Taik Lim ),유영옥 ( Young Ok Lew ),김은중 ( Eun Jung Kim ),이진우 ( Jin 대한폐경학회 2003 대한폐경학회지 Vol.9 No.4
목적 : 본 연구는 폐경 전과 폐경 후의 비정상 자궁출혈 환자의 진단에 있어서 경질 초음파 검사의 진단적 유용성을 알아보기 위해 자궁내막 생검에 의한 조직검사 결과와 비교분석하였다. 연구방법 : 1996년 1월부터 2001년 3월까지 가톨릭 의과대학 강남성모병원에서 기능성 자궁출혈로 자궁내막검사를 시행 받은 709명의 환자를 대상으로 하였음, 이중 조직 검사 상 부적절한 것으로 나온 28명은 대상에서 제외되었다. 자궁내막검사를 시행 받은 모든 환자들은 자궁내막 검사 전 경질 초음파를 이용하여 자궁내막 두께를 측정하였다. 조직학적 검사결과는 자궁내막암, 자궁내막증식증, 분비기, 증식기, Basal, Asynchronous의 6가지로 분류하였다. 결과 : 폐경 전 환자 581명중 조직학적 검사상 각각 경질 초음파로 측정한 자궁내막의 두께는 자궁내막암 16.5±92.mm, 자궁내막증식증 13.6±5.7mm, 분비기 13.1±4.9mm, 증식기 8.5±4.4mm, Asynchronous 7.7±4.4mm, basal 6.4±4.1mm로 자궁내막암과 자궁내막증식증, 분비기 사이에 유의한 차이가 없었다. (P >0.05) 폐경 후 여성에서 호르몬 치료를 받고 있지 않은 환자군은 60명이었으며, 각각 자궁내막두게는 자궁내막암 16.2±7.7mm, 자궁내막증식증 12.8±5.3mm, 분비기 10.2±60.mm, Asynchronous 10.0±0.0mm, Basal 8.5±49.mm, 증식기 7.2±4.6mm로 자궁내막암은 자궁내막증식증과 차이가 없었지만 다른 조직소견과는 통계학적으로 유의한 차이가 있었다. (P < 0.05) 폐경 후 여성 중 호르몬 치료를 받고 있는 환자군은 40명으로 각각 자궁내막두께는 자궁내막증식증 14.6±2.9mm, 자궁내막암 13.8±0.0mm, Asychronous 10.1±5.0mm, 분비기 93.±3.4mm, Basal 7.4±3.1mm, 증식기 6.0±3.4mm로 자궁내막암은 자궁내막증식증에서는 차이가 없으나 다른 정상 조직 소견과는 통계학적으로 유의한 차이가 있는 것으로 나타났다. (P < 0.05) 정상자궁내막 두께의 상한치를 5mm로 했을 때 폐경 후 호르몬 보충요법의 여부에 관계없이 100%의 민감도를 보였다. 결론 : 비정상 자궁출혈을 보이는 폐경 전 가임기 환자는 분비기에는 경질 초음파로 측정한 자궁내막의 두께로 병리적 이상여부를 선별하기 어려우므로 추가적인 검사가 필요하다. 폐경이 된 후에는 호르몬 보충요법의 여부에 관계없이 고식적 경질 초음파 검사가 자궁내막의 비정상조직검사 소견을 선별하는데 매우 유용한 비침습적인 검사법이며 높은 민감도를 보인다. 그러나 자궁내막의 두께만으로는 자궁내막증식증과 자궁내막암을 감별할 수 없었다. Objective: To assess diagnostic value of endometrial thickness using transvaginal sonography in premenopausal and postmenopausal women with or without hormone replacement therapy. Methods: Seven hundreds and nine patients with abnormal uterine bleeding were evaluated in this study. Endometrial thickness was measured by transvaginal ultrasonography before endometiral biopsy. 28 patients were excluded because their specimens were insufficient for making pathologic diagnosis. Results: Five hundreds and eighty one patients were premenopausal women, The thickness of endometrium could not discriminate endometrial hyperplasia and endometrial cancer from secretory endometrium in premenopausal patients. However, the endometrila thickness was significantly different in postmenopausal women between normal and abnormal pathology with or without hormone replacement therapy (P<0.05). But there were no difference of endometrial thickness in endometrial hyperplasia and endometrial cancer. 5 mm of the cut-off can exclude endometrial abnormalitie in postmenopausal women with or without hormone replacement therapy (sensitivity=100%). Conclusion: Endometrial thickness measured by conventional transvaginal sonography is still very effective to detect abnormal pathologic findings in postmenopausal womem regardless hormone replacement therapy with abnormal uterine bleeding. But It is not effective in premenopausal women with abnormal uterine bleeding.
임신능이 확인된 가임 여성에서의 Deciduosis의 유병율
김미란,유영옥,노덕영,류순원,권동진,김장흡,김진홍,임용택,김은중,정재근,이진우,Kim, Mee-Ran,Lew, Young-Oak,Ro, Duck-Yeong,Ryu, Sun-Won,Kwan, Dong-Jin,Kim, Jang-Heub,Kim, Jin-Hong,Lim, Yong-Taik,Kim, Eun-Jung,Jung, Jae-Keun,Lee, Jin-Woo 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.4
Objective: Extrauterine formation of decidua of stromal cells has been well described, particularly in the cervix and ovary. The apparent hormonal mechanisn of this phenomenon suggestes a relationship to endometriosis. Whether formation of ectopic decidua represents a marked progestational response of endometriosis or an independent peritoneal-stromal reaction to pregnancy is unclear. This study was designed to determine the prevalence of deciduosis in the patients whose fertility were proven. Design: Prospective study of patients who had undergone cesarean delivery without history of endometriosis. Materials and Methods: The study was performed in 179 full tenn pregnant women. During the cesarean section, the pelvic organs were thoroughly investigated and the biopsies were collected at the lesions suspicious endometriosis. And then microscopic examination of removed tissues were done. Results: Of the 179 patients who underwent cesarean delivery, 48 women (26.8%) had the lesions suspicious endometriosis such as adhesion, pigmented spots. The ovary was the most frequently ocurred site (79.2%). Microscopically, decidual cells were observed in 34 cases (70.8%) of 48 biopsed patients. Conclusion: Endometriosis has been known to be associated with subfertility. Our observations found the prevalence of deciduosis was 19.0% (34/179) in tenn pregnant women whose fertilites were proven. We suggests that the deciduosis maya manifestation of endometriosis during pregnancy. However, further follow up study should be done to confirm this clinicopathologic process.