A comparison of abdominal sacral colpopexy with total abdominal hysterectomy and McCall culdoplasty with vaginal hysterectomy in the treatment of uterine prolapse(초)

권하얀 ( Ha Yan Kwon ),( Yeo Jung Moon ),( Sei Kwang Kim ),( Sang Wook Bai ) 대한산부인과학회 2009 대한산부인과학회 학술대회 Vol.95 No.-

Krukenberg tumor arising from breast cancer: a case of the youngest patient in Korea(초)

권하얀 ( Ha Yan Kwon ),( Yong Wook Jung ),( San Hui Lee ),( Jiheum Paek ),( Eun Ji Nam ),( Sang Wun Kim ),( Jae Wook Kim ),( Young Tae Kim ) 대한산부인과학회 2009 대한산부인과학회 학술대회 Vol.95 No.-

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines

권하얀 ( Ha Yan Kwon ),( Ja-young Kwon ),( Yong Won Park ),( Young-han Kim ) 대한산부인과학회 2017 대한산부인과학회 학술대회 Vol.103 No.-

Objective: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. Methods: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. Results: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. Conclusion: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

유방암이 진단된 젊은 한국 여성에서 발견한 크루켄버그종양

권하얀 ( Ha Yan Kwon ),남은지 ( Eun Ji Nam ),김상운 ( Sang Wun Kim ),김영태 ( Young Tae Kim ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.10

Metastasis of breast cancer to lung, bone and liver is common, but metastasis to ovaries is rare in Korea. A 31-year-old woman diagnosed with breast cancer was referred to our department due to a newly detected adnexal mass via abdomen sonography during regular check-up. Imaging studies revealed solid mass on left ovary and enlarged lymph nodes. She underwent a laparotomy including hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy, with a suspected impression of primary ovarian neoplasms or Krukenberg tumors. Pathologic findings revealed metastatic adenocarcinoma from breast cancer involving left ovary and paraaortic lymph nodes. To our knowledge, this is the youngest Korean patient with Krukenberg tumors from the breast. In Korea, since the average age affected by breast cancer is younger than in the West, and the incidence and the mortality of breast cancer has increased, possible ovarian metastasis should be kept in mind when Korean patient with breast cancer visits for follow-up.

한국의 모성사망 원인과 경향 분석(2009-2014)

박현수 ( Hyun Soo Park ),권하얀 ( Ha Yan Kwon ) 대한주산의학회 2016 Perinatology Vol.27 No.2

목적: 본 연구는 2009년부터 2014년 사이 우리 나라의 모성사망 경향과 원인을 분석하고자 시행되었다. 방법: 모성사망의 경향과 원인을 분석하기 위하여 2009년부터 2014년까지 통계청에서 조사한 사망원인보완조사 결과를 사용하였다. 산모의 나이, 주거지, 사망원인, 사망 시 임신 주수 등의 정보를 추출하였다. 모성사망비(maternal mortality ratio)와 모성사망율(maternal mortality rate)을 계산하였으며 산모의 나이, 주거지역에 따른 모성사망비를 분석하였다. 모성사망의 원인을 세계보건기구(WHO)에서 제안한 기준으로 국제질병코드(ICD-10)를 이용하여 분류하였다. 결과: 연구기간 동안 평균 모성사망비는 13.16, 평균 모성사망율은 0.45였다. 모성사망비는 2011년에 17.2로 가장 높았고, 2012년 9.9로 가장 낮았다. 각 지역별 모성사망비는 광주 7.51, 제주 26.84로 큰 편차를 보였다. 연령별로는 20-24세 그룹이 6.9로 가장 낮았고 45-49세 그룹이 143.7로 가장 높은 수치를 보였다. 직접모성사망과 간접모성사망은 각각 평균 66.2%와 29.9%를 차지했다. 모성 사망의 3대 원인은 산과적 색전증(24.4%), 산후출혈(18.3%), 임신 중 고혈압성 질환(5.5%)으로 나타났다. 결론: 연구기간 동안 점차 모성사망비가 줄어들기는 했지만, 산모의 연령, 주거지 등에 따라 매우 큰 차이를 보였다. 모성사망을 줄이기 위한 방법으로, 모성 사망 중 예방가능한 원인에 대한 대처법을 찾고, 지역별로 이용가능한 의료자원의 편차를 줄이는 방법 등을 고려해 볼 수 있을 것이다. Purpose: This study was conducted to analyze recent trends and causes of maternal mortality in Korea between 2009 and 2014. Methods: We investigated trends and causes of maternal death using the data from Complementary Investigations on the Infant, Maternal, and Perinatal Mortality carried out by Statistics Korea between 2009 and 2014. Maternal age, administrative district, causes of death and gestational age at the time of death were collected from data. Statistics including maternal mortality ratio (MMR) and maternal mortality rate were calculated. We also analyzed MMR according to the age, and administrative districts. The causes of maternal death were sorted and classified using International Classification of Diseases and World Health Organization recommendations. Results: The average MMR during 6 years was 13.16 and maternal mortality rate was 0.45. MMR was highest in 2011 (17.2) and lowest in 2012 (9.9). The average MMR of the administrative districts varied greatly from 7.51 (Gwangju) to 26.84 (Jeju). The average MMR during the study period was lowest in maternal age of 20- 24 (6.9), and highest in 45-49 (143.7). On average, direct and indirect maternal deaths accounted for 66.2% and 29.9% of total maternal death, respectively. The three most common causes of maternal deaths were obstetrical embolism (24.4%), postpartum hemorrhage (18.3%), and hypertensive disease of pregnancy (5.5%) in decreasing order of frequency. Conclusion: Although MMR is decreasing during the study period, it fluctuates widely according to maternal age, districts, and constant effort for improvements is necessary. To reduce maternal deaths, solution to control preventable causes of maternal deaths, careful management of pregnancies with advanced maternal age, and policy to solve the discrepancy in the medical services among diverse regions in the country are needed.

골반장기 탈출증 환자의 복식 천골질고정술 수술 후 발생하는 배뇨장애 예측인자

박수연 ( Su Yeon Park ),권하얀 ( Ha Yan Kwon ),박정화 ( Jung Hwa Park ),문여정 ( Yeo Jung Moon ),김세광 ( Sei Kwang Kim ),배상욱 ( Sang Wook Bai ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.2

목적: 본 연구는 골반장기 탈출증의 수술적 치료인 복식 천골질고정술(abdominal sacrocolpopexy) 수술 후 발생하는 배뇨장애(voiding dysfunction)를 예측할 수 있는 인자를 알아보고자 한다. 연구방법 2007년 1월부터 2009년 12월까지 본원 산부인과에서 골반장기 탈출증으로 복식 천골질고정술을 시행받은 총 89명의 환자를 대상으로 후향적 연구를 시행하였다. 환자들의 POP-Q system에 따른 병기를 포함한 임상적 특징, 산과력, 수술력, 수술 후 도뇨관 제거일을 조사하였으며, 수술 전 시행한 요역동학 검사들의 결과를 검토하였다. 수술 후 배뇨장애가 발생한 환자들을 조사하여 배뇨장애가 발생하지 않은 환자들과 비교분석하였다. SPSS 프로그램을 이용하여 분석하였으며, χ2 test와 t-test를 이용하여 두 군의 차이를 비교하였고 다중회귀 분석을 이용하여 수술 후 배뇨장애의 발생에 영향을 미치는 요인들을 알아보았다. 결과: 복식 천골질고정술을 받은 89명 중 17명(19.1%)이 배뇨장애를 호소하였다. 배뇨장애가 발생한 환자군과 발생하지 않은 환자군의 임상적 특징 중 당뇨가 있거나(29.4% vs. 9.7%, odds rations [OR]: 3.87, 95% confidence intervals [CI]: 1.05-14.23), 도뇨관 제거일이 늦은 경우 (수술 후 4일: 47.1% vs. 13.9%, OR 5.51, 95% CI 1.72-17.64) 유의한 차이를 보였고 요역동학 검사결과 비교에서는 detrusor pressure at maximal flow rate (Pdet at Qmax)가 (13±8 vs. 23±15, per 10 cm H20, OR 0.54, 95% CI 0.31-0.95) 유의한 차이를 보였다. 다중회귀 분석을 통해 이들 중 Pdet at Qmax (OR 0.94, 95% CI 0.89-0.99)만이 통계적으로 유의한 차이를 보였다. 결론: 골반장기 탈출증 치료로 복식 천골질고정술을 시행하는 경우, 수술 전 시행한 요역동학 검사상 Pdet at Qmax가 낮을수록 수술 후 배뇨장애가 발생할 가능성이 증가한다. Objective: Although there were many studies about postoperative voiding dysfunction after anti-incontinence operation, little studies after pelvic organ prolapse operation were published. We sought to determine risk factors for voiding dysfunction (VD) after abdominal sacrocolpopexy (ASC). Methods: ASC was performed on 89 women at Yonsei University Health System from January 2007 to December 2009. VD was defined as post void residual (PVR)>150 mL. Foley catheter was removed after the third or forth postoperative day (POD). Risk factors for VD were examined using logistic regression models. Results: Seventeen patients (19.1%) had VD. Total abdominal hysterectomy (TAH) was performed on 70.8%, transobturator tape (TOT) on 55.1% concomitantly. There was no significant difference in age (mean±standard deviation [SD], 59.9±12.8 vs. 62.7±8.1 yr), parity (mean [range], 3 [1-5] vs. 3 [1-8]), body mass index (mean±SD, 24.0±2.7 vs. 24.4±3.6), TAH (70.6% vs. 70.8%), TOT (52.9% vs. 55.6%) and pelvic organ prolapse quantification stage 4 (94.1% vs. 68.1%, P-value 0.057). There was significant difference in diabetes mellitus (29.4% vs. 9.7%, odds rations [OR]: 3.87 [95% confidence intervals, CI: 1.05-14.23]) and the day of foley removal (POD 4: 47.1% vs. 13.9%, OR: 5.51 [95% CI: 1.72-17.64]). There was no significant difference in urodynamic parameters including maximal capacity, urethral closure pressure, maximal flow rate, mean flow rate, post void residual except detrusor pressure at maximal flow rate (Pdet at Qmax), (13±8 vs. 23±15, per 10 cm H20, OR 0.54 [95% CI: 0.31-0.95]). In the multiple logistic regression model, only Pdet at Qmax OR 0.94 (95% CI: 0.89-0.99) remained statistically significant. Conclusion Women with lower Pdet at Qmax are more likely to have VD after ASC.