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안가영 ( Ka Young Ahn ),홍재식 ( Jae Shik Hong ),김나영 ( Na Young Kim ),이현주 ( Hyun Joo Lee ),이희정 ( Hee Jung Lee ),최노미 ( Noh Mi Choi ),한호섭 ( Ho Seup Han ),성석주 ( Suk Joo Sung ),김주명 ( Joo Myung Kim ),주관영 ( Kwan 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6
Objective: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. Methods: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). Results: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5±33.4 min, 2.4±0.7 ㎎/dL, 5.2±1.4 days, 7.6±2.2 days vs. Group B 135.3±33.9 min, 2.9±0.8 ㎎/dL, 6.1±2.1 days, 9.4±3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. Conclusions: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.
자궁근종으로 진단된 환자의 치료 선호도 및 치료방법에 관한 고찰
조수희 ( Soo Hee Jo ),김주명 ( Joo Myung Kim ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김미라 ( Mi La Kim ),최규홍 ( Kyu Hong Choi ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ),주관영 ( Kwan Young Joo ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.11
Objective: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. Methods: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients` characteristics, treatment methods and questionnaires for patient preference were evaluated. Results: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. Conclusions: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.
자궁경수술로 성공적으로 치료된 점막하 낭성자궁선근종 2예
김남숙 ( Nam Sook Kim ),김주명 ( Joo Myung Kim ),김미라 ( Mi La Kim ),이시원 ( Si Won Lee ),주관영 ( Kwan Young Joo ),김혜선 ( Hye Sun Kim ),김희숙 ( Hy Sook Kim ),홍성란 ( Sung Ran Hong ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2
Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.
이원식(Won Sik Lee),김주명(Joo Myung Kim),심규민(Kuy Min Shim),캐더린박(Katherine Pak),주관영(Kwan Young Joo),이인국(In Kook Lee),김혜선(Hey Sun Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3
The mature cystic teratoma is most common in the ovary, and several authors have reported mature cystic teratoma in female genitalia such as fallopian tube, uterus and pouch of douglas. The mature cystic teratoma in the douglas pouch is very rare, which was reported only twice in the world. The pathogenesis of the mature cystic teratoma in the douglas pouch is not established. We experienced a case of mature cystic teratoma in the douglas pouch associated with pregnancy, which was diagnosed by the ultrasonography at the first trimester of pregnancy and remained at the third trimester of pregnancy without change of size. We report the case with a brief review of literature.
이희숙 ( Hee Suk Lee ),김주명 ( Joo Myung Kim ),유지희 ( Ji Hee Yoo ),육지형 ( Ji Hyung Yook ),김미라 ( Mi La Kim ),윤재범 ( Jae Bum Yoon ),주관영 ( Kwan Young Joo ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.5
Objective: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. Methods: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients` characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. Results: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn`t know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. Conclusion: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.
이희숙 ( Hee Suk Lee ),김주명 ( Joo Myung Kim ),이수윤 ( Soo Yoon Lee ),우장환 ( Jang Hwan Woo ),조연진 ( Yeon Jean Cho ),주관영 ( Kwan Young Joo ),최규홍 ( Kyo Hong Choi ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.3
Objective To assess changes in endometrial polyps by sonohysterography. Methods We conducted a retrospective analysis of 57 premenopausal women who were suspected to have endometrial polyps and were examined by sonohysterography from October 2005 to July 2008. We evaluated changes in endometrial polyps by sonohysterography after observation for two or more menstrual cycles. Results The mean age of the patients was 37.7, and all patients were premenopausal. Forty-two patients had bleeding symptoms, the most common being intermenstrual spotting. Endometrial polyps regressed spontaneously in 15 out of 57 patients (26.3%). The endometrial polyp regression rate was not associated with symptoms, age, body mass index, gravida, parity, initial largest polyp diameter or interval between sonohysterography. Of the 42 patients with persistent polyps, 29 received surgical treatment. None of the patients had malignant lesions. Conclusion Endometrial polyps in premenopausal patients with low malignant potential may be observed for about two menstrual cycles in the hope of spontaneous regression.
부인과 환자의 수술전 빈혈교정에 있어 GnRH agnoist와 정맥 철분제제의 비교연구
이희정 ( Hee Jung Lee ),김나영 ( Na Young Kim ),이현주 ( Hyun Joo Lee ),김미라 ( Mi La Kim ),조연진 ( Yeon Jean Cho ),김주명 ( Joo Myung Kim ),주관영 ( Kwan Young Joo ),이인국 ( In Kook Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.1
Objective: This study is aimed to compare the efficacy of GnRH agonist and intravenous iron therapy in women who need correction of anemia prior to hysterectomy for uterine myoma and adenomyosis. Methods: We reviewed retrospectively the data of 105 patients with initial hemoglobin level under 10g/dl, who had undergone total abdominal hysterectomy after correction of anemia with GnRH agonist (Group 1) or intravenous iron therapy (Group 2) from January 2004 to April 2006. Results: Initial hemogloblin level was not different between the two groups. After administration, hemoglobin level increased by 3.9±2.3 g/dl and 2.6±1.7 g/dl, respectively. Therefore, group 1 was superior in anemia correction (p<0.01). On postoperative 1st day, hemoglobin level was 10.3±1.6 g/dl and 9.0±1.0 g/dl. Correction duration was 7.8±4.7weeks (1-18weeks) in group 1 and 4.0±4.8weeks (1-30weeks) in group 2. Shorter duration was needed for correction in group 2 (p<0.01). Surgically removed uterine weight was 391.4±195.1 gm and 630.6±648.9 gm, respectively. Uterine weight was heavier in Group 2 (p<0.01). Conclusion: In comparison of efficacy of GnRH agonist with intravenous iron therapy for the correction of preoperative anemia, corrected hemoglobin level was higher and removed uterine weight was smaller in group 1. But duration of therapy for the correction of anemia was shorter and cost-effectiveness was superior in group 2. Clinicians should consider the patients` condition prior to the selection of drug for preoperative anemia correction.
GnRH agonist 사용 중 심한 자궁출혈 환자에서의 자궁의 모세혈관확장증
김미라 ( Mi La Kim ),김주명 ( Joo Myung Kim ),이원식 ( Won Sik Lee ),주관영 ( Kwan Young Joo ),이인국 ( In Kook Lee ),김혜선 ( Hye Sun Kim ),홍성란 ( Sung Ran Hong ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.1
Telangiectasis of the uterus is an extremely rare but life-threatening disease because of massive uterine bleeding. The usage of GnRH agonist can cause regression and atrophy of the endometrium through induction of hypoestrogenism by pituitary down-regulation. But there is no clear explanation or report in the literature showing the relationship between uterine telangiectasis and GnRH agonist usage. We have experienced a patient with uncontrolled massive uterine bleeding after GnRH agonist treatment, who needed emergency hysterectomy. Pathologic tissue examination showed telangiectasis of the endometrium and myometrium. This is the first case report of telagiectasis of the uterus without other organ involvement. We report this case with a brief review of the literatures.
유지희 ( Ji Hee Yoo ),김주명 ( Joo Myung Kim ),조연진 ( Yeon Jean Cho ),육지형 ( Ji Hyoung Yook ),이희숙 ( Hee Suk Lee ),김미라 ( Mi La Kim ),주관영 ( Kwan Young Joo ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.6
Objective: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. Methods: We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. Results: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). Conclusion: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.