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3차 병원에서 시행된 제왕절개술의 예방적 항생제 사용에 대한 전향적 다기관 연구
고지경 ( Ji Kyung Ko ),조용균 ( Yong Kyoon Cho ),양혜진 ( Hye Jin Yang ),박찬욱 ( Chan Wook Park ),박중신 ( Joong Shin Park ),전종관 ( Jong Kwan Jun ),김민균 ( Min Gyun Kim ),원혜성 ( Hye Sung Won ),이필량 ( Pil Ryang Lee ),김암 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.3
목적: 3차 병원에서 시행되는 제왕절개술 시 예방적 항생제의 투여기간과 첫 투여시기가 수술 후 감염성 이환율에 영향을 미치는가에 대해 알아보고자 하였다. 연구 방법: 이 연구는 전향적 무작위 배정 연구로서 2008년 12월부터 2009년 9월까지 3차 병원에서 제왕절개술을 시행 받는 임신부를 대상으로 하였다. A군은 수술 후 24시간 동안 B군은 수술 후 48시간 동안 예방적 항생제를 투여 받도록 하였다. 1세대 세팔로스포린계통의 항생제 사용하여 첫 투여 시기는 피부절개 30분내 혹은 제대 결찰 후로 하였다. 열성이환, 상처감염, 자궁내막염, 요로감염, 폐렴, 패혈증, 골반농양과 같은 감염성 이환의 발생율과 재원기간을 비교하였다. 결과: 연구대상은 총 413명이며 A군은 220명, B군은 193명으로 무작위 배정되었다. 두 군간의 연령, 임신분만력, 임신주수, 체질량 지수에는 의미 있는 차이는 없었다. 감염성 이환율은 1.9%였으며 수술부위 감염이 가장 높은 빈도로 발생되었다. 두 군 사이의 감염성 이환율과 재원기간에 통계학적으로 의미 있는 차이는 보이지 않았다. 또한 첫 항생제 투여 시기에 따른 감염성 이환율은 통계학적으로 차이가 없었다. 결론: 제왕절개술 시 사용되는 예방적 항생제는 단기 사용은 수술 후 감염성 이환을 예방하는데 다회요법 만큼 효과적이며 첫 항생제 투여시기는 수술 후 감염성 이환율에 영향을 미치지 않는다고 할 수 있겠다. 향후 항생제 사용기간과 첫 투여시기 그리고 신생아 예후에 대한 더 많은 연구가 필요할 것으로 사료된다. Objective: To determine whether the duration and timing of prophylactic antibiotics influence maternal postoperative infectious morbidity in cesarean section performed at tertiary center. Methods: This study was a prospective, randomized trial. Pregnant women who underwent cesarean section between December 2008 and September 2009 at tertiary center were enrolled and divided into two groups: Group A, antibiotic prophylaxis was applied for 24 hours and Group B, antibiotic prophylaxis was applied for 48 hours. First generation of cephalosporin was administrated within 30 minutes prior skin incision or after cord clamping. The occurrence of postoperative infectious morbidity such as febrile morbidity, wound infection, endometritis, urinary track infection, pneumonia, sepsis and pelvic abscess and hospital stays were compared. Results: There were 413 pregnant women enrolled and then randomized into 220 for group A and 197 for group B. No demographic differences were observed between two groups. The infectious morbidity was 1.9% (8/413) and wound infection was the most common postoperative infections morbidity. No significant difference was found between the groups for infectious morbidity and hospital stays. Also timing of prophylactic antibiotics did not result in significant difference for infectious morbidity. Conclusion: Short course of prophylactic antibiotics has been shown to be as efficacious as multidose of prophylactic antibiotics for preventing infectious morbidity in cesarean section and timing did not influence on infections morbidity. Further studies focusing on duration and timing of prophylactic antibiotics for cesarean section are needed.
폐경전 여성의 비정상 자궁출혈의 임상 및 병리학적 고찰 - 자궁내막 증식증의 예측 인자의 평가
고지경 ( Go Ji Gyeong ),최훈 ( Choe Hun ),강웅선 ( Kang Ung Seon ),김명환 ( Kim Myeong Hwan ),박기현 ( Park Gi Hyeon ),이철민 ( Lee Cheol Min ),조용균 ( Jo Yong Gyun ),김복린 ( Kim Bog Lin ),이홍균 ( Lee Hong Gyun ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.1
목적 : 비정상 자궁출혈 환자를 대상으로 임상적 병리학적 상호 연관성을 검토하고, 이를 통해 자궁내막 증식증의 예측 인자를 평가하고자 하였다. 연구 방법 : 1996년 1월부터 2003년 2월까지 인제대학교 상계백병원 산부인과에 비정상 자궁출혈을 주소로 내원하여 자궁 내막 소파술을 통한 자궁내막 검사를 시행한 폐경전 여성 500명을 대상으로 하였고 이중 임신과 관련된 출혈과 전신적 혈액질환이나 호르몬 투여의 경험이 있는 여성은 제외시켰다. 연령분포, 임 Objective : We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia Methods : We reviewed 500 premenopausal
부인과적 질환의 복강경 수술 750례에 대한 임상적 고찰
박기현,조용균,강웅선,김명환,고지경,이철민,최훈,김복린,이홍균 인제대학교 2003 仁濟醫學 Vol.24 No.1
Objective : To evaluate the clinical outcomes of operative laparoscopy in gynecologic disorders. Methods : Retrospectively, we reviewed the medical records of 750 patients who underwent operative laparoscopy from August 1992 to February 2003. We evaluated age, parity, previous abdominal operation, clinical indication, postoperative pathologic diagnosis, operation type, operation time and complication. Results : The results of this study were summarized as follows 1. The age of the patients ranged from 14 to 67 years and mean Parity of the patients was 1.33. 2. The common indications were adnexal mass (60.5%), ectopic pregnancy (27.2%) and uterine myoma (5.2%). 3. The common postoperative pathologic diagnosis were ovarian cyst (33.2%), tubal pregnancy (25.9%), endometriosis (19.6%). 4. The frequent types of surgery were salpingo-oophorectomy (30.5%), ovarian cystectomy (24.8%), salpingectomy (22.1%), and laparoscopic assisted vaginal hysterectomy (LAVH) (5.5%). 5. The operation time was varied from 15 minutes to 270 minutes according to the types of operation and the mean operation time was 91 minutes. 6. The complications were bladder dysfunction (0.9%), preperitoneal bleeding (0.5%), urinary tract infection (0.5%), subcutaneous emphysema (0.3%), hemoperitoneum (0.1%) and paralyticileus(0.1%). Conclusion : Laparoscopic surgery was minimally invasive surgical technique and effective procedure for treatment of gynecologic disorders. Today, operative laparoscopy is being applied in most of gynecologic disorders.
황희정,정희정,정은하,고지경,조용균,김복린,최훈 인제대학교 2007 仁濟醫學 Vol.28 No.-
Objective : The purpose of this study was to review the clinical presentation, size, prevalence, tumor marker, treatment, outcomes and histopathologic findings of ovarian neoplasmas in childhood and adolescence. Methods and Materials : Medical recordings of 155 patients aged 20 years or less with adnexal mass diagnosed at the Sanggye Paik Hospital from Jan. 1997 through Dec. 2006 were reviewed retrospectively Results : The mean age of patients was 16.9±2.8 years. Abdominal pain is the most frequent symptom. The mean diameter of ovarian tumor was 12.9±8.5㎝. The number of benign ovarian tumors were 141 cases(88.7%) and the number of malignant or borderline ovarian tumors were 18 cases(11.3%). According to histopathological classification of malignant or borderline ovarian tumors, germ cell tumors were 11 cases(61.1%) and epithelial cell tumors were 7 cases(38.9%). The mean value of preoperative serum CA125 levels was 39.6±26.6 U/mL in the benign group, and 136.3±117.2 U/mL in the malignant group. According to FIGO classification of malignant or borderline ovarian tumors, most patients (17 cases) were stage Ⅰ and only one patient was stage Ⅲ. Most patients underwent unilateral salpingo-oophorectomy in an attempt for reproductive organ conservation, one case of stage Ⅲ disease was treated with hysterectomy, bilateral salpingo-oophorectomy and omentectomy. On follow up, all 18 patients survived between 5 months and 9 years 11 months after treatment. Conclusion : The proportion of malignant or borderline neoplasms in childhood and adolescence group was 11.3%. Because of the potential for malignant ovarian neoplasm in this age group, the presence of ovarian neoplasms requires prompt evaluation and treatment.
폐경 여성에서 3년 동안 호르몬 요법, 랄록시펜, 알렌드로네이트 치료 후 혈청 지질과 체질량 지수의 변화
김명환,최훈,이지은,고지경,이철민,조용균,김복린 대한골다공증학회 2013 Osteoporosis and Sarcopenia Vol.11 No.1
Objectives: To evaluate the effects of 3-year hormone therapy, raloxifene and alendronate on lipid profile and body mass index (BMI) in Korean postmenopausal women. Methods: We studied 107 postmenopausal women who had visited the Department of Obstetrics and Gynecology of Inje University Sanggye Paik Hospital between January 2000 and June 2010. These patients were divided into alendronate (n=21), raloxifene (n=18), estrogen therapy (ET) (n=35), estrogen-progesterone therapy (EPT) (n=33) group. Serum lipid profile was measured at baseline and 1, 2, 3-year after treatment. BMI were also assessed at baseline and 3-year after treatment. Results: Total cholesterol level was decreased significantly after 3 years of treatment in EPT group by 5.0% and raloxifene group by 8.7%. Triglyceride level was decreased significantly after 3 years in alendronate group by 12%. HDL-cholesterol level was increased significantly after 2 years in ET group by 12% and EPT group by 6.0%. LDL-cholesterol level was decreased significantly after 1 year in ET group by 7.0% and EPT group by 13%. In raloxifene group, LDL-cholesterol level was decreased significantly after 3 years by 7%. BMI was not changed significantly after 3 years in all four groups. Conclusions: In postmenopausal women, the treatment with hormone therapy or raloxifene has a beneficial effect on lipid profiles. BMI was not changed.
증례 : 다모증을 주소로 내원하여 대사증후군을 동반한 청소년기 다낭성 난소증후군으로 진단된 2예
허경 ( Kyoung Huh ),고지경 ( Ji Kyung Ko ),박미정 ( Mi Jung Park ) 대한비만학회 2009 The Korean journal of obesity Vol.18 No.4
다낭성난소증후군(Polycystic Ovary Syndrome, PCOS)은 무월경 및 불임 등의 생식기계 문제 이외에도 대사증후군, 제2형 당뇨병, 심혈관 질환 등의 위험을 증가시키기 때문에 PCOS의 위험성이 있는 환자를 조기에 발견하고 치료를 시작하는 것이 장기적인 합병증을 예방하는데 중요하다. 비만한 여아에서 PCOS가 증가하고 있으나 청소년기에는 PCOS의 진단은 생리적인 무배란과의 감별과 다난포성 난소의 정확한 초음파진단의 어렵고, 청소년기 정상 안드로겐 수치가 없어 고안드로겐 혈증을 진단하기 어려운 제한점 등으로 인해, 소아기의 PCOS에 관한 연구보고는 드물다. 저자들은 다모증을 주소로 내원하여 대사증후군이 동반된 청소년기 다낭성 난소증후군으로 진단된 2예를 경험하였기에 보고하는 바이다. 두 환아 모두 허리둘레와 체질량지수 90백분위 이상으로 중심성 비만 상태였으며 이상지질혈증과 인슐린 저항성이 동반되어 있었다. 이 중 한 환아는 제2형 당뇨병에 이환되어 있는 상태였다. 두 환아 모두 Metformin 치료로 체중과 허리둘레가 상당히 감소하였으나 다모증은 큰 호전은 없었다. 소아청소년 연령의 PCOS의 metformin 치료에 대한 지속적인 연구가 필요할 것으로 사료된다. Polycystic ovary syndrome (PCOS) is diagnosed by a combination of oligo-anovulation, clinical/biochemical signs of hyperandrogenism, or ultrasound findings consistent with PCOS. It is also associated with metabolic abnormalities, such as dyslipidemia, obesity, and glucose intolerance. In spite of increasing awareness of PCOS in obese adolescents, its clinical diagnosis is often difficult. We report two cases of PCOS presenting with metabolic syndrome and hirsutism. They showed dyslipidemia, insulin resistance and central obesity with waist circumference above 90 percentile and BMI over 95 percentile for their age and sex matched reference value. One patient was diagnosed as having type 2 diabetes. After metformin treatment, there was a significant reduction in body weight and waist circumference but hirsutism was not improved. Careful, long-term observation of these adolescents is needed to evaluate therapeutic outcomes.