제왕절개 자궁적출술의 임상적 고찰

정영주(Young Ju Jeong),김종덕(Jong Duk Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

Objective: The aim of this study was to review 10 years experience of cesarean hysterectomy at our hospital. Methods: A retrospective study of 37 cases of cesarean hysterectomy between Jan, 1, 1989, and Dec, 31, 1998 was carried out and then method of delivery, maternal age, parity, indication for hysterectomy, amount of transfusion, factors associated with adhesive placenta, and complications of hysterectomy were analysed. Results: The incidence of cesarean hysterectomy was 1 in 639 deliveries. Overall, 0.55% of cesarean sections and 0.02% of vaginal deliveries were followed by cesarean hysterectomy. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy(p=.000, respectively). The most common indication of cesarean hysterectomy was adhesive placenta(54%). Placenta previa and two more prior cesarean delivery were main risk factors for development of adhesive placenta (Odds ratio: 9.6, 6.1, respectively; 95% Confidence interval: 2.1-43.5, 1.1-34.2, respectively). Although no maternal deaths occurred, maternal morbidity remained high, including need for transfusion in 29 patients(78%) intraoperative urologic injury in 1l) patients(27%), and pulmonary congestion or edema in 7 patients(19%). Conclusion: As the incidence of cesarean section and its association with placenta previa and/or accreta continue to rise, we may encounter Cesarean hysterectomy with increasing frequency. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.

제왕절개 자궁적출술의 임상적 고찰

조영채(YC Jo),박정원(JW Park),권석민(SM Kwon),고재환(JH Koh),김용봉(YB Kim),이응수(ES Lee),박성관(SK Park) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

Objectives: To review 19 cases of cesarean hysterectomy performed at Seoul Paik Hospital, College of Medicine, Inje University from January, 1986 to December, 1997. Methods: A retrospective study of all cases of cesarean hysterectomy was made, and method of delivery, maternal age, parity, indications for hysterectomy, amounts of transfusion, perinatal mortality, complications were reviewed. Results: Cesarean hysterectomy was performed in 14 of 2,964 Cesarean sections (0.47%) and in 5 of 7,173 vaginal deliveries (0.07%). The higher the age and the parity of patients, the higher incidence of Cesarean hysterectomy. The most common indication of Cesarean hysterectomy was uterine atony (47.4%), followed by uterine rupture (21.0%), placenta previa with adhesive placenta (15.7%), adhesive placenta (10.6%), uterine myoma with pregnancy (5.3%). All patients who underwent Cesarean hysterectomy received transfusion from 3 to 58 pints. In aspect of fetal outcome, live births were 15 cases (79.0%), 2 infants were still birth (10.5%), 2 infants were dead during early neonatal period (10.5%), so perinatal mortality rate was 21.0%. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coagulation, intestinal obstruction and wound hematoma. There were 2 maternal deaths, of which the causes were disseminated intravascular coaglulation. Conclusions: In spite of operative risks, Cesarean hysterectomy is a necessary life saving operation. Prevention of complications that give rise to hysterectomy and optimally timed surgery should decrease maternal morbidity and mortality.

제왕 절개 자궁적출술의 임상적 고찰

최성훈(Sung Hoon Choi),김민정(Min Jung Kim),최원석(Won Suk Choi),김태영(Tea Young Kim),길명도(Moung Do Kil),백경돈(Kyoung Don Baik),정우철(Woo Chul Jung) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

Objective : This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. Material & Methods : The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. Results : During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. Conclusion : Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.

제왕절개 자궁적출술에 대한 임상고찰

김영남,정대훈,이경복,성문수,김기태,김현찬 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Objective : To review of incidence, indications and complications associated with cesarean hysterectomy. Methods : We analyzed retrospectively 67 cases of cesarean hysterectomy performed from January 1994 to December 2001. Results : There were 67 cases of cesarean hysterectomy among 10,102 deliveries for a rate of 6.63 per 1,000 deliveries. Cesarean hysterectomy was performed in 65 of 2616 cesarean section (25.84 per 1,000 delivery) and in 2 of 7,486 vaginal delivery (0.27 per 1,000 delivery). Most frequent indications were abnormal placentation (79.1%)-placenta previa with uncontrolled bleeding (41.8%), placenta previa with adhesive placenta (32.8%) and adhesive placenta (4.5%)- and uterine atony (14.9%). Mean blood loss, blood transfusion and operative time was 1,936㎖, 5.6 pint and 109 min. respectively. The perioperative complications were anemia, postoperative fever, DIC, Urinary tract infection, vaginal stump bleeding and wound disruption. There was no perioperative maternal death. Conclusions : Cesarean hysterectomy is a necessary life-saving operation. Although maternal mortality is rare, morbidity remains high. Abnormal placentation has become the most common indication for cesarean hysterectomy.

Case Report : Placenta percreta with a vaginal fistula after successful management by uterine transverse fundal incision and subsequent cesarean hysterectomy

( Satoko Matsuzaki ),( Shinya Matsuzaki ),( Yutaka Ueda ),( Tomomi Egawa Takata ),( Kazuya Mimura ),( Takeshi Kanagawa ),( Eiichi Morii ),( Tadashi Kimura ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.5

Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature.

임상연구 : 제왕절개술과 전자궁적출술 환자에서 정맥자가통증조절을 이용한 수술 후 통증조절

전연수 ( Yeon Soo Jeon ),김용신 ( Yong Shin Kim ),주진덕 ( Jin Deok Joo ),인장혁 ( Jang Hyeok In ),최진우 ( Jin Woo Choi ),강유진 ( Eu Jin Kang ),김대우 ( Dae Woo Kim ),임용걸 ( Yong Gul Kim ),이정아 ( Jung Ah Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: Postoperative pain degree is variable according to the site, type, and method of operation. This study compared the pain degree and amount of analgesics required among 3 types of operation. Methods: Ninety patients were selected that cesarean section (Group I, n = 30), open total hysterectomy (Group II, n = 30), laparoscopic total hysterectomy (Group III, n = 30) were scheduled. Patients received PCA with basal rate 2 ml/h, bolus 1 ml, lockout interval 5 min using fentanyl and ketorolac. We evaluated VAS at 30 min, 2, 6, 12, 18, 24, 36, 48 h postoperatively, demand of button and attempt of button, 6 hourly used amount of analgesics; side effects and degree of satisfaction after 24, 48 h postoperatively. Results: The rest VAS decreased below 30 at 6 hr in group I & II and at 2 hr in group III. More analgesics were needed for the first 6 hr compared with remained time in 3 groups (group I vs. group II vs. group III, P < 0.05). Total amount of analgesics including loading dose were fentanyl 1,536 ± 342μg, ketorolac 167 ± 34 mg for group I; 1,212 ± 215μg, 132 ± 30 mg for group II; 866 ± 125μg, 97 ± 27 mg for group III (group I vs. group II vs. group III, P < 0.05). Conclusions: The postoperative pain was painful as order of cesarean section, open total hysterectomy, and laparoscopic total hysterectomy. The pain was reduced 6 hr in laparotomy and 2 h in laparoscopy. (Korean J Anesthesiol 2007; 52: 166~71)

제왕절개 자궁적출술의 임상적 고찰

김용욱(Yong Yook Kim),김석영(Suk Young Kim),황병철(Byung Chul Whang),이종민(Jong Min Lee),최유덕(Yu Duk Choi),한양석(Yang Seok Han),이지성(Ji Sung Lee),노성혁(Seong Hyeok Noh),김장수(Jang Su Kim),최태행(Tae Haeng Choi),최용민(Yong Mi 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.7

Objective : To study the prevalence, indications, and outcome of cesarean hysterectomy in women delivered at the Gil Medical Center, Gacheon Medical School. Method : This is a retrospective study of all cases of cesarean hysterectomy performed between January 1995 and December 1999. Results : The incidence of cesarean hysterectomy was 0.4% (122/31,481). Cesarean hysterectomy was performed in 100 of 17,829 cesarean sections (0.6%) and in 22 of 13,652 vaginal deliveries(0.2%). The higher the age and the parity of patients, the higher the incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(50 cases, 41.9%), followed by 25 cases of placenta previa with adhesive placenta(20.5%), 14 cases of adhesive placenta(11.5%), 11 cases of uterine myoma with pregnancy(9.0%), 9 cases of uncontrolled bleeding with placenta previa(7.4%), 7 cases of uterine rupture(5.7%) and 6 cases of extension of uterine incision(4.9%). All patients who had cesarean hysterectomy received transfusion from 0 pint to 78 pints. Live births were 115 cases(94.3%) and 3 infants were still birth(2.5%). Four infants were dead during early neonatal period(3.3%), so perinatal mortality rate was 5.7%. The postoperative complications were bladder injury, ureteral injury, febrile morbidity, disseminated intravascular coagulopathy, hematoma, wound disruption, postpartum cardiomyopathy, and vaginal stump bleeding. There was two maternal deaths due to acute, severe hemorrhage and DIC. Conclusion : Cesarean hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. The procedure itself is usually associated with considerable perioperative morbidity. Obstetricians should identify patients at risk and anticipate the procedure and complications.

제왕절개 자궁적출술의 임상적 고찰

곽희중(HJ Kwak),추민호(MH Chu),이선경(SK Lee),김승보(SB Kim),이재현(JH Lee) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2

This report was undertaken to determine the present status of cesarean hysterectomy . cesarean hysterectomy was originally derived to prevent postcesarean infection and hemorrhage and reduce the maternal morbidity and mortality after the operation and its indications have gradully been widened to include many conditions in which removal of uterus is necessary or desirable. In this study, the outcomes of 64cases of cesarean hysterectomy performed at Kyung Hee University Hospital for 10 years from January, 1984 to December, 1993 were reviewed. There were 17,605 deliveries during this period, cesarean hysterectomy was prefomred in 53 of 4,930 cesarean sections (1.07%) and in 11 of 12,675 vaginal deliveries(0.087%) so more frequency after cesarean section than vaginal delivery. the age of patients varied from 21 to 42 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indications of cesarean hysterectomy was uterine atony (50%), followed by placental disoredrs (34.38%) uterine myoma with pregnancy (14.06%) and uterine rupture (1.56%). All patients who had cesarean hysterectomy received transfusion from 1 pint to 52 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coagulopathy and wound disseminated intravascular coagulopathy. Postoperative complication still remains the main cause of materanal mortality, therefore, carefull prenantal care, momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjuction with maternal lifesaving.

제왕절개 자궁적출수술의 임상적 고찰

정갑인,남계현,이해혁,이순곤,이권해,김동희 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Objective: This study was evaluated twenty-six cases of emergency Cesarean hysterectomy to analyse incidence, age distribution, parity, indications, complications, amount of blood transfusion and fetal morbidity. Methods and Materials : This study was carried out on twenty-six cases who underwent emergency Cesarean hysterectomy at department of obstetrics and gynecology, Soonchunhyang University Hospital from January 1987 to November 1997. Results: 1. The incidence of Cesarean hysterectomy was perfomed in 26 cases among total 19,277 deliveries(0.1%). 2. The indications of Cesarean hysterectomy were uterine atony, placenta previa, adhesive placenta and bleeding tendency. 3. There was matenal death in one case and main cause of death was massive bleeding due to disseminated intrabascular coagulopathy. 4. The complications of Cesarean hysterectomy were disseminated intravascular coagulopathy, bladder injury, postoperative infection, wound disruption and postoperative hemoperitoneum. 5. Two cases of fetal and neonatal mortality were intrauterine fetal death and neonatal death. Conclusion : The incidence of Cesarean hysterectomy was increased by increasing parity and maternal age.

산후 출혈로 제왕절개 자궁적출술을 시행받은 41 예의 임상적 고찰

박준혁(JH Park),노정석(JS Rho),문태식(TS Moon),전대준(DJ Jeon),장영우(YW Jang),구자남(JN Koo),박영세(YS Park) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

Objective: To evaluate the causes and maternal outcomes in patients who received cesarean hysterectomy operation. Methods: Forty one patients received cesarean hysterectomy at Ulsan university hospital for the 11 years, from January 1987 to December 1997. Results: The incidence of cesarean hysterectomy was 0.21% (41/19,485 deliveries). Cesarean hysterectomy was performed in 32 of 4,917 cesarean sections (0.65%) and in 9 of 14,568 vaginal deliveries (0.062%). The higher the age and parity of patients, the higher the incidence of cesarean hysterectomy were noted (p<0.05, respectively). The most common indication of cesarean hysterectomy was placental disorders (41.4%), and that was followed by uterine atony (36.6%), uterine rupture (9.8%), uncontrolled bleeding with placenta previa (4.9%) and uterine myoma with pregnancy (4.9%). The postoperative complications were febrile morbidity, urinary tract infection, bladder injury, disseminated intravascular coagulopathy and wound disruption. There was one maternal death, the cause was sepsis and congestive heart failure. There was no significant difference between two operation methods in the aspect of postoperative complications (p>0.05). Conclusion: Postoperative complication still remains the main cause of maternal mortality and morbidity. Therefore, careful prenatal care, momentary judgement of right operation time must be conjunction with maternal lifesaving.