자궁근종에 대한 Real time 초음파 소견과 임상학적 소견의 비교연구

박형배(HB Park),서병희(BH Suh),목정은(JE Mok),이재현(JH Lee) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.4

저자들은 1981년 12월부터 1983년 2월까지 약 1년 3개월 동안 부인과외래에서 임상증상 및 골반내진으로자궁근종이라고 생각되는 경우에 초음파 응용을 한 후개복수술을 시행하여 조직검사상 자궁근종이라고 확인된 30예에서 근종의 크기, 위치, 경계부, 이차성 변화근종의 유형, 현미경적 병리병소, 자궁내막 등에 대한초음파 양상과 병리조직소견간의 상관관계에 대해 비교한 결과 다음과 같은 결론을 얻었다. 1. 자궁근종 크기에 따른 초음파 양상은 직경이 10cm이상인 경우에 57%에서 혼합양상을 보였고, 직경이 10cm이하인 경우에는 2예만 제외하고 고음양상을 보였다. 2. 자궁근종은 자궁체부에서 가장 많이 호발되는 양상을 보였고, 근종의 위치에 대한 초음파 검사의 정확도는 기저부의 경우 80%, 체부인 경우에는 90%의 정확성을 나타냈으며 자궁경부와 원인대에 발생한 근종은 초음파 검사시 발견못하고 수술후 확인되었다. 3. 근종의 경계부는 초음파 소견시 60%에서 불분명하였고, 분엽된 경우가 3예인대 반해 수술후 전예에서경계부를 명확히 구별할 수 있었다. 4. 초음파 검사시 보였던 자궁근종의 이차성 변화는수술후 조직검사에서 특히 낭포성 변화는 초음파 검사시 12예가 4예로 비교적 큰 차이를 보였다. 5. 초음파 검사시 근층내 근종 유형이 26예로 가장많았고, 초음파 양상과 근종 유형과의 특별한 상관관계를 찾을 수 없었으나, 근층내 근종유형에서는 주로 고음양상을보였고, 장막하 종양 유형에서도 전예에서 고음양상을 보였다. 병리조직상 자궁근종의 근층내 근종 유형은 19예로 초음파 검사시와 7예의 차이를 보였고, 초음파 검사소견시와 다른 전체적으로 커진 근층과 여러 유형이 같이 존재하는 예가 5예 있었다. 6. 조직병리병소인 조직피사, 초자질 변성, 출혈, 낭포성 변화, 석회화 변화등은 혼합양상만 보일 뿐, 각병소마다 각기 특징적인 초음파 양상을 보이지 않았다. 7. 초음파 소견과 자궁내막 소견과는 특별한 상관관계가 발견되지 않았으나 조직 검사상 내막증식기 17예중 13예에서 고음양상을 보였고, 내막분비기 13예중 6예에서 중증도음양상을 보였다. 8. 초음파 검사시의 자궁근종 크기에 대한 조직검사시의 크기 차이가 10% 미만이 70%가 속하며, 3예만이 50%이상의 오차를 보였다. 앞으로는 내진에 의해 자궁근종이라고 진단이 내려진 경우에도 초음파 검사를 응용하여 자궁근종에 대한확진과 크기에 대한 정보를 얻을수도 있고 초기임신및 다른 골반내종과의 감별을 기할 수 있고 초음파양상에 의해 특히 혼합양상을 보일 때는 이차성 변화를 강하게 암시받을 수도 있으며 더우기 환자의 전신상태와 다른 검사결과로 비교해 약성자궁 종괴에 대한감별을 할 수 있다는 것이다. 본 저자는 산과영역 뿐만 아니라 부인과 영역에서도적극적인 방법으로 초음파 검사를 이용해 골반내 종괴진단과 특히 난소종양의 악성 및 양성종양의 감별과 종양의 유형에 대해서 그리고 난소낭종의 염전에 대해서도 초음파를 응용해서 후향성 연구결과를 토대로 전향성 연구로 발전시킬 수 있다고 생각한다. Myoma is the most common of the uterus and estimated that fully 20% of all women over 35 years of age harbor uterine myoma. Nothing definite is known of the etioIogy of uterine myomas, although it is established that they are of muscle histogenesis. The source is from immature cells. Their growth, however, is somewhat estrogen dependent. They do not appear until menarche and usually diminish in size after menopause, on occasion, myomata will grow after the menopause, when this occures, the possibility of sarcomatous change must be considered. Secondary changes in myoma ara hyaline degeneration. cystic degeneration, calcification, infection, suppuration, necrosis fatty degeneratlon and sarcomatous change. Hyaline degeneration is the most common of all secondary changes. Differntial diagnonsis of uterine myoma are a rather large retroflexed fundus, solid tumor of ovary, inflammatory or neoplastic adnexal masses and early pregnancy. The use of ultrasound may he useful. This is the study of 30 cases whose patients are suggested to uterine myoma under the clinical symptoms and by bimanual pelⅵc examination at the dept. of Obstet. & Gynecol., Kyung Hee University hospital from December l981 to Feburary 1983, and after being applied by ultrasonography, operation was performed and then uterine myoma was confirmed by histological analysis. We attempt to analysis the size, location, demarcation, secondary change, type, microicopic findings and endometriai findings of myoma uteri. The following is the result of study; 1. About 57% of myoma uteri which is measured by diameter over lOcm have shown the mⅸed pattern on sonographic finding in relation to size of myoma., but below 10cm, shown echogenic pattern except 2 cases. 2. On uterine body, it is occurred the most commonly and accuracy of ultrasonography which is concerned to the location of uterine myoma is 80% in the fundal region and 90% in the uterine body. Uterine myoma which is occurred on cerⅵx and round ligament is not detected by ultrasonography and it is confirmed after operation 3. The demarcation of uterine myoma is not cear in 6O% by ultrasonography and 3 cases are lobulated, but all cases which is found postoperatively, is well demarcated. 4. In secondary changes of uterine myoma, there are moderate differentiations between the ultrasonographic findings and histological findings especially cystic and hyaline degeneration˙ 5. ln sonography, interstitial type is the most common type, there is no relation between the ultrasonographic findings and type of myoma.

자궁근종 有無에 따른 素症 차이 연구

윤영진(Young-Jin Yoon),조정훈(Jung-Hoon Cho),장준복(Jun-Bock Jang),이경섭(Kyung-Sub Lee),이준희(Jun-Hee Lee) 대한한의학회 2009 대한한의학회지 Vol.30 No.2

자궁근종 1례에 대한 임상보고

이보라,신용완,이정은,정진홍,유동열 대한한방부인과학회 2004 大韓韓方婦人科學會誌 Vol.17 No.1

During the reproductive years, the most common uterine myoma are benign, but the possibility of malignancy must be considered. Genenally uterine myoma are also benign, and two-thirds of these occur in women between 30 and 45 years of age. Which produce few of only mild, nonspecific symptoms. The most common symptoms include abdominal pain or discomfort, low abdominal pressure sensation, hypermenorrhea and urinary symptons comprise. The treatment of uterine myoma is just observation, operation and taking the hormone replacement theraphy in western medicin. This report is performed to evaluate the effectiveness of Resonance Therapy and herd-med on uterine myoma. After this treatment, the size of the uterine myoma were reduced with a significant data or dismissed. So, it indicates Resonance Therapy and herb-med is effective on the patient with uterine myoma, but continous observatin and study are needed.

A case report of traditional Korean medicine treatments on uterine myoma with thyroid cancer

Chae-Hak Lim,유정은 한국한의학연구원 2018 Integrative Medicine Research Vol.7 No.4

Uterine myoma is a common benign tumor. When the symptoms are not severe, patients are often suggested to wait for menopause without treatment. If the size becomes too large or the symptoms get worse, the patient will receive surgery or hormone therapy. If a patient does not receive surgery or hormone therapy because of the waiting period, traditional Korean medicine (TKM) treatment can be applied. This is a case of a 47-year-old woman who was diagnosed with thyroid cancer and uterine myoma. She was diagnosed with thyroid cancer in 2012 and uterine myoma in 2013. She had not received treatments. In December 2017, the size of the uterine myoma increased to more than 8 cm, and the patient suffered from dysmenorrhea, urination frequency, and vaginal discharges. She wanted TKM treatment instead of surgery or hormone therapy. From January 16, 2018 to April 12, 2018, she received TKM treatment; herbal medicine, acupuncture, moxibustion, and pharmacopuncture. Before the treatment, the urination frequency was more than 10 times a day, but decreased to 6–7 times a day after treatments. Dysmenorrhea decreased from VAS8 to VAS5 after treatments. After menstruation, the duration of vaginal secretion persisted for 3–4 days, but after treatments, it was visible only for a 1 day after menstruation. Ultrasonography showed that the thyroid cancer did not worsen and the size of uterine myoma decreased by 2 cm. It is considered that TKM treatment, as a substitute for surgery or hormone therapy, will exert positive effect on uterine myoma without the aggravation of thyroid cancer.

자궁근종의 보존적 치료를 위한 질식 고주파 자궁근종용해술

황인택 ( In Taek Hwang ),노정훈 ( Jeong Hoon Rho ),김기환 ( Ki Hwan Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.2

목적: 자궁근종의 치료에 이용한 질식 고주파 자궁근종용해술의 임상적 효과 및 안정성에 대해 분석하고자 한다. 연구 방법: 2005년 5월부터 2006년 3월까지 자궁근종의 진단 하에 본원에서 질식 고주파 자궁근종용해술을 시행 받은 67명을 대상으로 하였다. 시술 전 경복부 및 경질 초음파를 이용하여 근종의 크기, 개수, 위치 그리고 부피를 측정하였으며, 시술 후 1개월, 3개월, 6개월 후 동일인에 의해 근종의 크기 및 부피를 측정하였고. 시술 후 매 방문마다 생리과다, 생리통, 부정기 출혈 그리고 근종의 압박증상 (빈뇨, 골반통) 등의 근종 특이증상의 호전 유무를 추적, 관찰하였다. 결과: 67명 환자의 평균 연령은 42.2세였다. 근종의 평균 개수는 1.18개였고, 평균 최대직경은 5.52 cm이었으며, 평균 부피는 89.9 cm3였다. 각 근종 당 평균 시술시간은 15.1분이었고, 평균 시술횟수는 1.4회였다. 근종의 평균 최대직경은 시술 후 1개월, 3개월, 6개월에 각각 14.2%, 22.8%, 29.8%의 감소율을 보였으며, 평균 부피는 각각 34.9%, 52.5%, 63.6%의 감소를 보였다. 초기 증상이 없었거나 폐경 후인 8명을 제외한 59명 중 3개월, 6개월에 각각 45명과 37명의 증상을 확인할 수 있었다. 생리통의 증상 호전은 각각 86.7%, 82.8%를 보였고, 생리양과다는 각각 65.2%, 60%의 증상 호전을 보였다. 위의 두 가지 증상이 모두 동반된 경우에는 각각 85%와 81.2%의 증상 호전을 보였다. 시술 후 합병증으로는 일시적인 하복부 통증이 7명, 질출혈이 1명, 시술 후의 발열 및 복부 불편감으로 내과로 전과된 경우가 1명이었다. 그 외 심각한 합병증은 한 예도 없었다. 결론: 질식 고주파 자궁근종용해술은 자궁을 보존할 수 있고, 보다 비침습적이며, 근종의 크기 및 증상의 감소에 뛰어난 효과가 있어, 기존의 방법들을 대체할 수 있는 자궁근종의 치료로서 많은 효과가 있을 것으로 기대된다. Objective: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. Methods: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. Results: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. Conclusion: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.

Ileo-uterine fistula in a degenerated posterior wall fibroid after Caesarean section

Shehata, Ayman,Hussein, Naglaa,El Halwagy, Ahmed,El Gergawy, Adel,Khairallah, Mohamed The Korean Society for Reproductive Medicine 2016 Clinical and Experimental Reproductive Medicine Vol.43 No.1

Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.

거대 자궁근종 치료를 위해 자궁동맥 색전술을 시행한

문혜경 ( Hye Kyoung Mun ),김진석 ( Jin Suk Kim ),신승호 ( Seung Ho Shin ),조태일 ( Tae Il Cho ),김정욱 ( Jung Wok Kim ),황호경 ( Ho Kyong Hwang ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

Uterine myomas are the most common benign tumor of the female genital organ. Uterine artery embolization is well reported of primary treatment of uterine myoma. A 29 year-old nulliparous woman was diagnosed as uterine myoma by ultrasonogram. We embolize b

Uterine Perforation after High-Intensity focused Ultrasound Treatment for Adenomyosis

Sat Byul Kim,Mi Jung Um,Suk Jin Kim,Mi Ja Lee,Hyuk Jung 조선대학교 의학연구원 2016 The Medical Journal of Chosun University Vol.41 No.4

High intensity focused ultrasound (HIFU) treatment of uterine myoma is a non-invasive procedure that uses high intensity, focused ultrasound to heat and destroy the tissue of uterine myoma. The history of using therapeutic ultrasound dates back to the early 20th century, and since, the technique has been continuously improved to an extent that the breadth of its clinical applications, both diagnostic and therapeutic, justify the integral role it plays in medicine today. HIFU treatment requires that ultrasound beams be focused on targeted uterine myoma. Due to significant energy dissipation at the focus, temperatures within tissues increase to more than 65℃, and destroy diseased tissue. This technology can achieve precise "ablation" of myoma tissue, and because it destroys diseased tissue non-invasively, it is also known as "Non-invasive HIFU surgery". Development of this technology significantly broadened the range of treatment options for patients suffering from uterine myoma. Furthermore, in contrast to surgery, HIFU requires only a short period of hospitalization and has a low complication rate. Today, HIFU is being used more frequently to treat adenomyosis, but its increased use has led to the reporting of more complications. Here, the authors report a case of uterine perforation after HIFU ablation for adenomyosis.

자궁근종에서의 Phospholipase C 발현에 관한연구

윤혜원 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Phosphoinositide-specific phospholipase C(PLC) is one of the key molecules in signal transduction for celular activity such as proliferation and differentiation. However, the biological significance of their molecules in carcinogenesis or tumor progression is not defined yet. Using PLC isozyme - specific antibodies, the relative contents of PLC isozyme have been examined in uterine myoma and normal myometrium. Immuno-reactive analysis revealed considerably hither levels of PLC-γ1 protein in all uterine myoma and little difference in PLC-β1, when compared to normal myometrial tissue. From Western blotting, PLC-γ1 showed 3 to 4 fold more expression in uterine myoma than that in normal myometrial tissue. There also is a linear relationship between activity and amount in PLC-γ1 increase of myoma. Taken together, the fact that the majority of uterine myoma displays elevated level of PLC-γ1 expression implies that PLC-γ1 mediated signal transduction may have significant role in proliferation and differentiation of myoma.

초음파로 진단된 자궁근종의 위험인자 평가

양성희(Yang Sung-Hee) 대한방사선과학회(구 대한방사선기술학회) 2021 방사선기술과학 Vol.44 No.4

The purpose of this study was to analyze the risk factors for uterine myoma diagnosed by ultrasonography in Korea women and to evaluate the risk. Among the patients who visited the outpatient department of obstetrics and gynecology at I hospital in Busin between January 2019 and March 2021 for the purpose of examination, 98 patients in the experimental group diagnosed with uterine myoma and 163 patients in the normal control group without other diseases were retrospectively conducted. Among the general characteristics of the subjects, age, body mass index, parity, and menopause showed significant differences between the myoma group and the normal control group. ROC(receiver operating characteristic) curve analysis and logistic regression analysis were performed to obtain the cut off value and odds ratio that can predict the occurrence of uterine myoma. The cut off value for the prediction of uterine myoma was determined to be 30 years old and a body mass index of 23 kg/m2. After that adjusting for menopause, non menopausal cases with a body mass index of 23 kg/m2 and over 39 years of age had the highest odds ratio of 6.04. Therefore, premenopausal women over 40 years of age require regular checkups and thorough weight management. This study was conducted with a small number of subjects. Therefore, there is a limit to generalizing to all Korean women. However, based on this study if a large scale prospective study considering various variables is made, it can play a role as a predictive marker in early detection of uterine myoma.