임신 36 주와 동반된 난소 Krukenberg 종양 1 례

김정호,서승식,김경수,백인숙 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.8

위의 원발암종이 임신과 더불어 난소에 전이된 것으로 보이는 Krukenberg 종양 1례를 경험 하였기에 문헌고찰과 함께 보고하는 바이다. Krukenberg tumor is rare ovarian neoplasm and hard to early detection Krukenberg tumor of the ovary associated with pregnancy is very rare. The definite diagnosis of the Krukenberg tumor would be pathologic diagnosis with surgical specimen. The tumor characterized by the infiltration of the interstitium and the signet ring cell was metastasized from the G-I tract, predominantly . We have experinced one case of Krukenberg tumor associated with the 36 weeks gestation recently, which was found on cesarean section. And so the literatures on Krukenberg tumor of the ovary are reviewed briefly, in addition to reporing this cases.

자궁부속기 염전의 복강경적 보존적치료에 대한 임상적연구

박창수,서승식,권미숙,유현,한상국 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

목적: 본 연구의 목적은 자궁부속기 염전 의 이해와 자궁 부속기 염전의 복강경적 보존적 치료의 효과를 평가하기 위함. 연구 방법: 1993년 1월부터 1998년 8월까지 자궁부속기 염전으로 전주 예수 병원 산부인과 입원한 48명환자를 토대로 연구됨. 결과: 본 연구의 결과는 다음과 같다. 평균 나이는 28.5세 가장 흔한 증상은 하복부 동통 염전된 난소의 평균 크기는 9.4 cm 가장 흔한 염전의 정도는 360°[41%] 염전된 난소의 가장 흔한 조직 병리학적 소견은 낭성 기형종이다. 염전된 난소 혈관경에 색도플러 초음파를 실시한 7예중에서 4예는 동, 정맥 혈류가 관찰되지 않아서 난소 및 자궁부속기 절제술을 시행했고 3예에서는 동,정맥 혈류가 관찰되어서 복강경적 보존적 치료가 시행되었다. 복강경적 보존적 치료가 시행된 모든 예에서 색전증 이나 초음파 추적 검사에서 종양 재발이 발견되지 않았으며 또한 난포성장이 관찰되어 난소기능이 정상이 됨을 확인하였다. 결론: 자궁 부속기 염전이 있는 젊은 가임기 여성에서 색도플러 초음파상 혈류가 존재하는 경우에 난소 보존을 위한 복강경적 보전적 치료는 효과가 있는 방법이다. Objective: Our purpose was to evaluate the adnexal torsion and the effect of laparoscopic conservative therapy for adnexal torsion. Method: In the discriptive study the chart of 46 patients admitted from 1993 January to 1998 August with a diagnosis of adnexal torsion were reviewed. Result: The results of the study were as follows ; the mean age is 28.5 years old, the most common symptom was lower abdominal pain, the mean size of twisted ovary was 9.4cm, the most frequent degree of torsion was 360 degree[41%], the most common histopathologic type of twisted ovary was cystic teratoma. Color Doppler sonography of twisted ovarian pedicle was performed in 7 cases. In 4 cases, in which pedicle arterial and venous blood flow was absent, adnexectomy was performed. In 3 cases, in which pedicle arterial and venous blood flow was present, laparoscopic conservative therapy was performed. Conservatively managed cases was no cases of embolic complication or tumor recurrence during follow up ultrasonography and recovery of ovarian function was subsequently proven by ultrasonographic evidence of follicular growth. Conclusion: We concluded that laparoscopic conservative therapy in the young child bearing women with adnexal torsion was effective method for ovarian preservation in the cases of presence of Doppler flow on color Doppler sonography.

생식아세포종을 동반한 Swyer씨 증후군에서 복강경적 성선제거 1 예

김재홍,서승식,김경아,권미숙,유현,김영숙 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

저자들은 표현형이 외견상 정상 여성이고 내생식기로 자궁 난관이 있고 일측에는 색상생식선과 반대측에 생식아세포종을 동반한 고환 퇴행증후군 중 Swyer씨 증후군 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. Phenotypic female with a 46,XY Karyotype have approximately a 25% chance of developing a malignancy in the dysgenetic gonad. Malignancies occur in relatively young individuals. For this reason, it has been recommanded that all patients with Y-chromosomal material and dysgenetic gonads undergo gonadectomy. We report a case of gonadoblastoma with 46,XY Swyers syndrome, which was managed by laparoscopic adnexectomy.

임신과 동반된 급성전골수구성 백혈병의 1예

최주원,서승식,정은신,이형열,이영혜,이춘희 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.7

반복자연유산의 세포유적학적 연구

김종덕,진소자,서승식,김관식,김난경 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.12

저자는 전라북도 지역에서 자연유산아의 염색체 이상의 빈도 및 종류를 알아봄으로써 반복적인 자연유산을 호 소하는 환자들의 상담 및 치료에 유용한 정보를 얻기 위하여 1988년 5월부터 1994년 6월까지 전북대학교병원 산부인과에 자연유산을 주소로 내원한 환자와 남편의 정맥혈을 이용하여 세포 유전학적 검사를 시행하여 다음 과 같은 결과를 얻었다. 1. 염색체 이상의 빈도는 43.7%였고 상염색체 삼체성이 46.7%를 가장 많았으며, monosomy X 가 24.5% 구조적 이상이 15.6%의 빈도를 보였다. 2. 상염색체 삼체성중 16번이 38.1%로 가장 높은 빈도를 보였고, 21번이 23.7%, 18번이 19.0%의 순위였다. 3. 나이에 따른 염색체 이상의 빈도는 큰 차이를 보이지 않았으나 autosomal trisomy 의 빈도는 모성 나이가 많아짐에 따라 다소 증가하였다. 4. 염색체의 구조적 이상을 보인 9예에서 양쪽 부모 중 하나가 염색체이상을 갖는 경우는 6예(66.7%)였다. 이상과 같은 결과로 전라북도 지역에서 자연유산아의 염색체이상의 빈도는 서구의 보고와 비슷하였으나 구조 적 이상의 빈도가 비교적 높았으며 이들은 대부분 부모에서 유래되는 유전적인 것으로 판명되어, 차기 임신의 적절한 처치를 위해서는 산전 유전상담 및 가족의 염색체 검사가 병행되어야 함을 시사해 주고 있으며 나이가 많아짐에 따라 상염색체 삼체성의 빈도가 증가되는 것으로 미루어 고령산모에서 유전상담 및 산전염색체 검사 가 필수적임을 재확인할 수 있었다. 삼체성중 특히 18번의 빈도가 서구의 보고에 비해 높았는데 이에 대한 배경을 밝히기 위해서는 자연유산아에 대한 보다 많은 국내의 연구례가 집약되어져야 할 것으로 생각된다. It has been known that chromosomal abnormalities of abortus is the most common cause of spontaneous abortion, but the frequency and the type were reported variations in different countires and races. In order to evaluated the frequency and type of chromosomal abnormalities of abortus in Chonbuk provincial area, a cytogenetic study was performed in 119 abortuses and their aborters from May. 1988 to June, 1994 in Chonbuk National Unviersity Hospitial. The frequency of abnormal karyotypes in abortuses was 43.7% ; autosomal trisomy was predominent (46.7%), followed by monosomy X(24.4%) structural aberrations (15.6%) and polyploidy (6.7%). Among trisomies, chromosomes 16(38.1%), 21(23.7%) and 18(19.0%) were prevalent. There was no statistical significance of frequency of chromosomal abnormality by maternal age, but trisomy was slightly increased in elder women. The frequency of structural aberrations was significantly higher than western countries, and almost of the abnormalities were inherited from their parents. An additional study is necessary to explain the prevalence of trisomy 18 in this area than western countries.

여성 골반내 종양의 임상 및 병리학적 고찰

이영혜,이형열,서승식,공지원,최주원,정은신 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.10

1989년 1월 1일부터 12월 31일까지 1년간 여성 골반내에서 발생한 종양으로 전주 예수병원 산부인과에 입원하여 수술을 받은 300예를 대상으로 임상적 및 병리학적 연구로 다음과 같은 결과를 얻었다. 1. 연령별 분포는 41∼50세가 38.65로 가장 많았고, 평균 연령은 42.1세이었다. 2. 분만횟수는 3∼4회가 37.3%로 가장 많았다. 3. 임상증상은 하복부 동통이 30.6%로 가장 많았고 이상자궁출혈과 이물촉진이 그 다음 순이었다. 4. 종양 종류로는 자궁근종이 가장 많았고 양성난소종양이 다음 순이었다. 5. 41∼50세에는 자궁근종이 51.8%로 가장 많았다. 6. 21∼30세에는 양성 난소종양 및 비종양성 난소낭이 가장 많았다. 7. 11∼20세에는 악성 난소종양이 가장 많았다. 8. 악성종양은 4.6%이었다. 9. 수술방법은 복식 전자궁절제술 및 자궁부속기절제술이 68.3%로 가장 많이 시행되었다. 10. 수술시간은 80%가 30분에서 1시간 30분사이 이었다. 11. 수술후 합병증은 빈혈이 23%로 가장 많았다. 12. 수술전 자궁근종으로 진단된 경우 82.5%에서 수술후 자궁근종으로 진단되었다. 13. 수술전 난소 종양인 경우 80%에서 수술후 난소종양이었다. 14. 수술전 악성 난소종양을 의심한 경우 44%에 서 수술후 악성난소종양이었다. A clinico-pathological studies were made on a series of 300 patients having a diagnosis of pelvic mass/uterine myoma, who were admitted, operated and confirmed histopathologically at the Department of Obstetrics and Gynecology, Prebyterian-Medical Center, Chun Ju, from January 1. 1989 to December 31.1989. The results were as follows; The average age was 42.1 years old with the highest frequency in 5th decade. The most common chief complaint of pelvic mass was lower abdominal pain or discomfort, revealed in 30.6% of the cases. Among the pelvic mass, leiomyoma was most frequently revealed in 56.0% and benign ovarian tumor was revealed in 25.3%. Leiomyomas were observed most frequently in the age group 41 to 50 years. Benign ovarian tumor or functional cyst was the most prevalent finding in women aged 21∼30 years. In the age group in 11 to 20 years, malignant ovarian tumor was most frequently observed. The incidence of malignant tumor was 4.6% among all pelvic mass. Total abdominal hysterectomy with unilateral or bilateral salpingo-oophorectomy was most frequently performed in 68.3%. Leiomyomas were found in 82.5% of 194 patients with a preoperative diagnosis of leiomyma. Ovarian tumors were found in 80% of 100 patients with a preoperative diagnosis of ovarian tumors. Malignant ovarian tumor were found in 44% of 25 patients with a preoperative diagnosis of malignant ovarian tumor.

임신중 발생한 난소종양의 임상적 고찰

최영민,김재홍,서승식,김창배 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

The fifty three cases of ovarian tumors in pregnancy among 27,466 deliveries seen at Department of Obstetrics & Gynecology, Presbyterian Medical Center;from January 1st, 1990 to December 30th, 1995, were clinically observed and statistically reviewed. The diagnosis of ovarian tumor was confirmed by pathologist after operation(laparotomy). The results obtained were as follows: 1) The incidence of benign ovarian tumors in pregnancy was 1 in 518 deliveries. The incidence of malignant tumor in pregnancy were 2 in 27,446 deliveries and the one case was endometrioid cancer, the other case was Krukenberg tumor. 2) Mean age was 24yrs old and the range was 18∼33 yrs old. Mean parity was 0.4. 3) As to the initial chief complaints or the mode of presentation, no symptoms & signs were in 31 cases(59.1 %) low abdominal pain in 12 cases(22.7 %) was found in 12 cases(22.7 %), palpable mass were 10 cases(18.2 %). 4) As to the timing of diagnosis, 27.3 % was diagnosed in the 1st trimester, 68.1 % in the 2nd trimester, 4.5 % in the 3rd trimester. 5) According to the method of diagnosis, known ovarian tumors were 17 cases(31.8 %), 31 cases(59.1 %) were found by physical examination and ultrasonography and 5 cases(9.1 %) were incidental finding during cesarean section. 6) As to the size of tumor, 2 cases(4.5 %) were less than 6 cm in diameter, 34 cases(63.6 %) were 7∼10 cm, 7 cases(13.6 %) were 11∼15 cm, and 10 cases(18.3 %) were over 16 cm. 7) According to the type of operation, unilateral oophorectomy was performed in 29 cases(54.7 %), unilateral salpingoophorectomy in 13 cases(24.5 %), unilateral cystectomy in 4 cases(7.5 %), unilateral ovarian wedge resection in 5 cases(9.4 %), bilateral right oophorectomy with left ovarian wedge resection in 2 cases(3.9 %). 8) According to the histopathologic type, there were 22 cases(41.5 %) of cystic teratoma, 11 cases(20.8 %) of simple cyst(9.4 %) of serous cystadenoma, 6 cases(11.3 %) of corpus luteal cyst, 5 cases(9.4 %) of mucinous cystadenoma, 2 cases(3.8 %) of endometrial cyst., one case(1.9 %) of Krukenberg tumor and endometriod cancer, respectively. 9) As to incidental of complications resulting from ovarian tumors 15 cases(28.3 %), being 10 cases(18.9 %) of torsion, 4 cases(7.5 %) of rupture, 1 case(1.9 %) of mechanical obstrution. 10) Among the reviewed cases, 51 cases(96.1 %) were unilateral and 2 cases(3.9 %) were bilateral. 11) According to outcome of pregnancies & mode of deliveries, 48 cases(90.25) were followed up. Among them, term delivery in 44 cases(81.6%), among them, vaginal delivery in 42 cases, cesarean section in 2 cases(2.4%) and spontaneous abortion in 3 cases(6.2%) and artificial abbortion in 1 case(2.4%) were occurred. 5 cases(9.8%) were not followed up.

자궁외임신의 임상적 고찰

최영민,이영호,서승식,최화국,최귀동,이향숙 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.5

1991년 1월 1일부터 1995년 12월 31일까지 만 5년간 전주예수병원 산부인과에서 자궁외임신으로 입원수술한 환자 116예를 임상적 고찰하여 다음과 같은 결론을 얻었다. 1. 분만건수에 대한 자궁외임신의 빈도는 1:168명(116예/19,497건)이었다. 2. 호발연령은 25-29세가 40.5%로 가장 많았다. 3. 분만횟수와의 관계에서 미산부의 자궁외임신이 29.3%를 차지하였고, 한번도 임신 안한 미임부가 30.2%를 차지하였다. 4. 최종월경 제 1일부터 증상발현하여 내원하기까지의 기간은 6-8주사이가 44.8%로 가장많았다. 5. 기왕력은 인공유산의 경험이 74.1%, 복강경불임시술 15.5%, 자궁외임신 12%, 제왕절개술 6.9%를 차지하였다. 6. 주요 임상증상에서 하복부동통이 88.7%, 질출혈이 57.8%, 무월경이 59.4% 등으로 주 증상을 보였다. 7. 자궁외임신 진단방법으로 소변 임신반응검사 양성율은 97.4% 였으며, 더글라스와천자 양성율은 71%로 나타났고, 복강경진단 양성율은 85.2%, 초음파진단상 자궁부속기 종괴 및 더글라스와 액상소견은 44.3%에서 나타났다. 8. 자궁외임신 발생부위는 난관이 92.2%로 가장 많았고, 난소 4.3%, 자궁경관 0.9%, 광인대 2.6%를 보였다. 그리고 형태에 따라 파열형이 69.1%, 사산형이 31%, 비파열형이 0.9%을 보였다. 9. 혈청 B-HCG치는 1,000 mIU- 5,000 mIU가45.8%로 가장 많았다. 10. 복강내 출혈량은 500 ml미만이 45.8%로 가장 많았고, 500-1,000 ml가 18.9%, 1,000-2,000 ml가 17.3%를 차지하였다. 11. 혈청 B-HCG치가 1,000 mIU/ml이하인 경우가 33%였고, 혈청 B-HCG치와 자궁외임신 크기의 연관성은 뚜렷하지 않았다. 따라서 혈청 B-HCG치를 이용하여 자궁외임신 크기를 예측하는 것은 유용하지 못할 것으로 사료된다. 12. 수술방법은 대부분 개복수술로 환측 난관절제술이 47.5%, 환측 난관절제술과 비환측난관결찰술이 10.3%로 대다수를 차지하였으며 복강경에 의한 환측 난관절제술도 9.5%를 차지하였다. 13. 116예 자궁외임신으로 입원 후 수술 중, 후 사망한 예는 없었다. This study is a clinica evaluation and statistical analysis on the 116 cases of ectopic prognancies who were admitted and treated at Department of Obstetrics and Gynecology, Presbyterian Medical Center from January 1, 1991 to December 31, 1995. The results obtained were as follows; 1. The medical center incidence of ectopic pregnancy was 1 in 168 deliveries. 2. The most frequent age group was in 25-29 years group. 3. Nullipara was 34 cases(29.3%) and the number of cases had 1, 2 deliveries were 34 cases (29.3%), 39 cases (33.6%). 4. The most frequent interval between last menstrual period and the onset of symptoms was 6-8 weeks in 52 cases(44.8%). 5. In the past history, 86 cases(74.1%) had previous artificial abortion, 18 cases(15.5%) had laparoscopic tubal sterilization, 14 cases(12%) had previous ectopic pregnancy, 8 cases (6.9%) had previous cesarean section. 6. On the smptomatological studies, lower abdominal pain was noted in 103 cases(88.7%), vaginla bleeding(spotting) in 67 cases(57.8%), amenorrhea in 62 cases(53.4%). 7. Urine hCG test was positive in 113 cases(97.4%) and culdocentesis was positive, 61 cases(71%). and diagnostic laparoscopy was positive in 23 cases(85.2 %). On the sonograghic findings, adnexal mass and cul-de-sac fluid finding was positive in 39 cases(44.3%). 8. Ectopic pregnancy was implanted on fallopian tube in 107 cases(92.2%), and 5 cases(4.3%) on ovary, 1 case(0.9%) on cervix. In tubal pregnancy, the most implantation site was ampullar portion 76 case(65.5%). Ruptured tubal pregnancy was 79 cases(68.1%). 9. The most common range of serum B-HCG level was 1,000 mIU-5000 mIU in 35 cases(41.1%). 10. Intraperitoneal blood loss below 500 ml in amount was 53 cases(45.8%), 1,000-2,000 ml in 20 cases(17.3%), respectively. 11. The serum B-HCG level was below 1,000 mIU/ml in 28 cases(33%). The serum B-HCG levels relate poorly with the size of a ectopic pregnancy. 12. Most commonly used operative procedure was ipsilateral salpingectomy in 55 cases (47.5%), ipsilateral salpingo-oophorectomy in 8 cases(6.9%) and also, laparoscopic salping ectomy was done in 11 cases(9.5%). 13. In the 116 study cases, there was no fatal case.

조산 억제제로서의 Ritodrine Hydrochloride (Yutopar) 의 임상적효과

이봉구,이영혜,오병전,서승식,공지원 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.4

저자들은 1986년 1월부터 1987년 4월까지 조기진통의 진단하에 전주예수병원 산부인과에 입원한 산모에서 Ritodrine투여를 시행하고 분만시까지 추적된 25명의 산모를 대상으로 연구 분석하여 다음과 같은 결과를 얻었다. 1. 산모들의 연령 임신주수 임신력에서는 유의한 차이가 없었으며, 자궁경부개대 및 자궁경부 소실상태나 tocolysis score치는 치료성적과 유의한 관계를 보였다. 2. 1주일이상의 분만지연 혹은 임신37주이후의 분만을 치료성공의 기준으로 했을때 치료성공률은 32%이었으며, 평균 분만지연일은 25일이었다. 3. Ritodrine투여시 임산부의 혈압과 태아의 맥박수는 유의한 차이를 보이지 않았으나 임산부의 맥박수는 유의하게 증가하였다. 4. 치료 실패요인은 심한 모체 빈맥 감염 질출혈과 무반응 예로 구분되는데 무반응 예가 전체 실패 예의 76%로서 가장 많았다. 5. Ritochine투여로 인한 신생아의 Apgar score의 저하는 없었다. Preterm delivery accounts for 70 % of the perinatal mortality and morbidity and is therefore the principal target of obstetric dept. The beta-adrenergic agonist such as ritodrine hydrochloride (Yutopar) has demonstrated a significant prolongation in the duration of pregnancy and a decrease in immediate neonatal morbidity through several placebo-controlled studies in recent years. This study was conducted for the evaluation of the effectiveness of ritodrine hydrochloride on 25 patients selected in 104 patients admitted with preterm labor from January, 1986 to April, 1987. The results of this study were as follows: 1. There was no significant difference in clinical characteristics such as maternal age, gestational weeks, gravity and parity. But the high tocolysis score, progressed cervical dilatation and good cervical effacement were noted in the failure group. 2. The total success rate of tocolysis was 32 % and the mean time gained by ritodrine was 25 days. 3. There was no significant difference in maternal blood pressure and fetal heart rate during ritodrine infusion but the maternal tachycardia was noted. 4. The causes of treatment failure were severe maternal tachycardia, infection, vaginal bleeding and unresponsiveness. The unresponsiveness cases were 76 % of the total failure group. 5. The mean Apgar score of neonate born before 34 weeks of gestation was 4.8 (1-min)/7.3(5-min) and 7.2(1-min)/9.1(5-min) after 34 weeks gestation. There was no decrease in Apgar score from ritodrine infusion.

자궁외임신의 임상적 고찰

최화국,최귀동,이향숙,최영민,서승식,이영호 예수병원 1997 예수병원학술지 Vol.18 No.-