자궁내막선암의 임상병리학적 고찰

송인철(IC Song) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.2

1. 자궁내막선암의 발생빈도는 전 부인암중 3.8%를 차지하였고 자궁경암에 대한 비율은 1:19.8이었다. 2. 환자의 평균연령은 52세이었고 연령분포는 51~60세에서 가장 높은 빈도를 보였다. 3. 환자의 미경산율은 25% 이었다. 4. 평균 폐경기연령은 49.8세이었고 월경력과의 관계는 폐경기 이후가 50%로 가장 많았고 폐경기가 28.6%, 性성숙기가 21.4%이었다. 5.내과적 또는 부인과적 합병증으로는 불임증 29.2%, 고혈증 16.6%, 자궁근종 및 선근증이 각각 12.2%, 비만 8.2%의 순서이었으며 당뇨병은 1예도 없었다. 6. 자각증상은 불규칙한 자궁출혈이 88.4%이었으며 이중 폐경기 후 출혈이 46.2%로서 가장 많았고, 하복통 및 대하를 호소한 예가 각각 34.6% 이었다. 7. F. I. G. O의 임상분류법에 의하면 제1기 57.8%, 제2기 15.6%, 제3기 15.6%, 제4기 11.7 % 이었으며, Broder`s 분류법에 의한 조직학적 grade는 제1도 54.0%, 제2도 11.7%, 제3 도 23.4%, 제4도 11.7%이었다. 8. 임상적 stage와 조직학적 grade 및 조직학적 grade와 자궁근층침윤은 연관성이 있는 것 으로 추측되었으나 연령과 임상적 stage 및 연령과 자궁근층침윤은 연관성이 없는 것으로 추측되었다. 9. 조직학적 진단으로서는 자궁내막선암이 88%, 선극세포암이 12%이었다. 10. 난소의 병리조직학적 소견은 낭포성변화 30.4%, 피층기질증식 13.0%, 전이성자궁내막 선암과 부난소낭종이 각각 4.2%이었다. 11. 예비적 진단법으로 세포진을 28예중 20예(71.4%)에서 시행하였으며 그 진단적 정확성은 25%이었다. 12. 최종진단방법은 진단적 자궁내소파 50.0%, 부분적 소파 35.7%, 자궁경부의 생검 7.1%, 개복술 및 용종절제술이 각각 3.6%의 순위이었다. 13. 수술요법을 시행한 24예중 복식자궁절제술 및 양측부속기절제술을 시행하였던 예가 16 예(66.6%)로 가장많았고 복식광범위자궁절제술 및 골반임파선절제술을 행하였던 예가 6예(25.0%)이었고 전장기적출술 및 시험개복을 행하였던 경우가 각각 1예(4.2%)이었다. 14. 수술을 시행하였던 24예의 수술후 추적성적은 5년생존율이 확인된 예가 5예뿐이었으며 이는 모두 임상 제1a기에 속하였다. 총괄적인 5년생존율은 례수가 많지 않고 추적불가능한 예가 많아 단언할 수 없다. A Clinico-Pathological study was made on a series of 28 endometrial cancers experienced at the Department of Obstetrics and Gynecology, National medical Center during the period from January 1, 1959 to October 31, 1975. The results obtained were as follows; 1) The incidence of endometrial cancer of all gynecological malignancies was 3.8% and the ratio of the endometrial caner to cervical cancer was 1 : 19.8. 2) Age distribution of endometrial cancer was concentrated on the age group of 51-60 and average age was 52 years. 3) The frequency of nulliparity was 25%. 4) Regarding the menstrual status, a half of all cases occurred in woman beyond monopause, the proportion being 50.0% postmenopausal, 28.6% perimenopausal and 21.4% menstruating. Average age at menopause was 49.8 years. 5) Associated medical and gynecological conditions were as follows: Infertility was noticed in 29.2%, hypertension in 16.6%, myoma and adenomyosis in 12.2% respectively, obesity in 8.2%, and no diabetes mellitus. 6) As to the presenting symptoms, abnormal bleeding was encountered in 88.4%, commonly postmenopausal in 46.2%, and lower abdominal pain and vaginal discharge were in 34.6%, respectively. 7) According to the clinical stage adopted by FIGO in 1970 and histologic grading by Broder`s classification, stage I was found in 57.8%, stage 2 in 15.6%, stage 3 in 15.6% and stage 4 in 11.7%, and grade I was seen in 54.0%, grade II in 11.7%, grade III in 23.4% and grade IV in 11.7%, respectively. 8) Clinical stage, histologic grade and myometrial invasion were seemed to be related to each other such as well differentiated tumors were found relatively in a earlier stage and the greater the degree of dedifferentiation of the cells, the greater the myometrial invasion. 9) Regarding the ovarian pathology, cystic change was found in 30.4%, cortical stromal hyperplaia in 13.0, secondary adenocarcinoma and parovarian cyst in 4.2%, respectively. 10) Vaginal cytology as a preliminary diagnostic procedure taken from 20 cases, over pap class III was found 5 cases (25%). 11) Diagnosis was made by endometrial curettage in 50.0%, fractional curettage of endometrium in 35.7%, cervical biopsy in 7.1% and laparotomy in 3.6%, respectively. 12) All cases were primarily treated by surgery. Regarding the types of operation, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 66.6 %, radical hysterectomy with both pelvic lymphadenectomy in 25.0% and total exenteration and exploratory laparotomy in, 4.2%, respectively. 13) It was very hard to get 5 yesr survoval rate because of insufficient follow-up study. Only 5 cases of stage Ia revealed over 5 year salvage.

양성난소기형종의 자연파열 3예

장명익(MI Chang),송인철(IC Song),박인서(IS Park) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.10

난소임신의 1예

윤석환(SH Yoon),송인철(IC Song),김서규(SK Kim),박수배(SB Park) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.3

본 증례는 Spiegelberg`s criteria에 충족한 난소임신의 1례였으며 해부학소견으로 원발성난소임신이라고 사료되었다. A case of ovarian pregnancy after laparoscopic sterilization which fulfilled spiegelberg`s criteria for a primary ovarian pregnancy in a 37 year-old multiparous woman is presented with the brief review of literature.

자궁에 발생한 혈관근지방종

배평원(PW Bae),송인철(IC Song),박영주(YJ Park),최근해(GH Choi) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.7

We experienced a cases of Angiomyolipoma of the uterus who was adimtted to our ob and gyn. Department of Obsterics and Gyunecology, the impression of the ovarian tumor of undetermined site. After laparatomy we confirmed the tumor mass was uterine tumor which was reported as angiomyolipoma through pathological examination. The angiomyolipoma is considered as benign mixed mesodermal tumor composed of the various component that is vesseles, muscles fatty tissues, elstic tissues, etc. This tumor has much rare incidence in the uterus but relatively common incidence in the kidney. We present this tumor because of its rarity and interesting pathological entity.

제왕절개수술에 대한 임상적 고찰

김경태(KT Kim),박찬용(CY Park),송인철(IC Song),박인서(IS Park) 대한산부인과학회 1977 Obstetrics & Gynecology Science Vol.20 No.12

1967년 1월초부터 1976년 12월말까지 만 10년간 국립의료원 산부인과에서 시행한 제왕절개술 1121예중 의무기록이 만족스러웠던 705예에 대한 임상통계학적 고찰을 다음과 같은 결과를 얻었다. 1) 제왕절개술의 빈도는 총분만수 12,742예중 1121예로 8.8%에 해당되었으며 이중 의무 기록이 만족스러웠던 705예에 대한 빈도는 5.5%에 해당되었고 대체적으로 매년 증가하 는 추세이었다. 2) 제왕절개술의 적응증은 아두골반불균형이 27.5%로 가장 많았으며 반복제절24.5%, 태위이상 16.5%, 전치태반8.8%, 태아절박증 6.1%등의 순위이었다. 3) 일반적으로 임신중독증 자체만으로는 제절의 적응증이 되지 못하였으나 (자간전증 4.6%, 자간증 25%) 태반성질환 즉 전치태반은 48.6%, 태반조기박리는 16.4%에서 제절 을 행하여 높은 빈도를 나타내었다. 4) 술식의 종류로는 자궁경부횡절개술이 663예(94.0%), 자궁체부종절개술 38예(5.4%), 제왕절개자궁척출술이 4예(0.6%)이었다. 5) 마취방법은 전신마취 610예로 86.5%, 전신마취 및 국소마취가 91예(12.9%), 척수마 취가 4예(0.6%)이었다. 6) 신생아 체중 별분포는 3,001∼3,500gm군이 268예로 37.0%를 차지하여 가장 많았으 며 미숙아는 87예로 12.1%이었고 성숙아는 636예로 87.9%이었다. 7) 총주산기사망은 59예로 주산기사망율은 8.3%이었으며 사산 37예, 신생아사망 23예의 분포이었고 미숙아군이 32예로 과반수를 차지하였다. 8) 모성사망은 3예로 0.43%에 해당되었다. 9) 제왕절개술과 병행된 수술예는 292예로 41.4%에서 시행하였고 난관피임수술이 233 예(79.9%)로 가장 많았고 충수적출술이 6.9%, 난소난관적출술이 3.4%의 순위이었다. 10) 수술중 출혈량은 평균 600cc이었고 500cc이하가 63.9%이었다. 11) 모성합병증은 이환율이 29.8%이었고 가장 빈번한 증상은 원인불명의 고열이 44.2% 이었고 뇨로감염증이 22.8%, 복부창상감염이 14.8%등의 순위이었다. The rise in incidence of Cesarean section has been noteworthy in many areas of our country since mid of 1960s. There are several reasons, but basic justification lies in lowering of maternal mortality with an increasing fetal salvage rate as compared with certain operativr procedures of vaginal delivery. This study was retrospectively carried out based on the clinical charts of patients who had 705 Cesarean sections performed at the department of Pbstetricw & Gynecology, National Medical Center from January 1967 to December 1976. The results were as follows; 1. Cesarean section rate was 5.5% in 12,742 total deliveries. It has been a tendency to gradual increment. 2. the indications for Cesarean section were cephalo-pelvid disproportion (27.5%) that was most prevalent, repeat section(12.5%), malpresentation(16.5%),placenta previa(8.8%), fetal distress(6.1%)and so on. 3. There was no absolute indication of Cesarean section rate in toxemic pregnancy, but high rate was noted in antepartum hemorrhage cases such as placenta previa(48.6%) and abruptio placentae(16.4%) 4. Low cervical section was performed in 94.0%, classical section in 5.4% & Cesarean hysterectomy in 0.6% 5. Types of anesthesia was general(86.5%), local and general(12.9%) and spinal (0.6%) 6. The weight group of 3,001-3,500g, comprised of 37.0% of all newborns. In comparison with prematurity and maturity, prematurity was 12.5%, and mature infant was 87.9%. 7. perinatal mortality rate was 8.3%. Its main carses were prematurity, abruptio placentae and so on. 8. Them were 3 maternal deaths in 12,742 pregnant woman, and a mortality rate was 0.43%. 9. Of 292 combined operations with Cesarean section, tubal ligation(79.9%), appendectomy(6.9%), and salpingooophorectomy(3.4%) were noted. 10. Average blood loss during operation was estimated about 600cc and blood loss under 500cc was observed in 63.9%. 11. Among the complication of Cesarean section, puerperal fever was the most frequent(44.2%), urinary tract infection(22.8%), abdominal wound infection(14.8%) and so on.

Krukenberg 종양 18예

김경태(KT Kim),박찬용(CY Park),송인철(IC Song),박인서(IS Park) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.12

There is a high incidence of carcinoma of the stomach in Korea and it has lead to the general impression that there are large number of Krukenberg Tumor . Eighteen Krukenberg Tumor among 980 cases of ovarian tumors were found in the hospital records at National Medical Center for 18 year from Jan. 1959 to Dec 1976. The results as follows; 1. The incidence of the Krukenberg Tumor among ovarian tumor (980 cases ) and malignant ovarian tumor (149 cases) were 1.8 percent, 12.1 percent respectively. 2. Average age was 43 years with range of 19 to 63. 3. Clincal symptoms and signs were abdominal pain and distension, abdominal mass, ascites menstrual irregularity and GI symptoms in order of frequency. 4. Abdominal pain and mass in 12 cases was present for 1 to 5 months before diagnosis. 5. Primary site of carcinoma was found in the stomach in 12 cases breast in a case and colon in one cases. 11 patients (61.1 percent) were bilateral.

견위분만에 대한 임상적 고찰

김성심(SS Kim),김성자(SJ Kim),송인철(IC Song) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.12

1) 둔위분만의 빈도는 단태분만의 경우에는 2.9%, 단태 및 쌍대분만 전체로서는 3.8%였다. 2) 분만회수에 따른 빈도는 초산부에서 3.1% 이상 경산부에서 2.1% 이상이었다. 3) 임신주수는 38주 이상이 71.9%였고 태아체중은 2,500gm 이상이 72.6%였다. 4) 질식분만 209예 중에는 frank breech가 가장 많아 76예, 다음 incomplte breech 66예, complete breech 20예의 순이었다. 5) 분만방식은 partial extraction이 65.7%, 제왕절개술이 13.6%, 자연분만이 11.2%이고 total extraction이 6.2% 기타 3.3%의 순이었다. 6) 질식분만에서의 분만시간은 24시간 이내에 분만이 끝난 예가 초산부에서는 약 78%, 경 산부에서는 약 84%였다. 7) 모체 및 태아의 합병증으로는 임신중독증이 가장 많아 66예, 양막조기파수 26예, 협골반 12예, 태아가사 16예, 제대탈출 13예가 있었으며 그 외에 전치태반, 태반조기막리, 지연분만, 태반계유, 산후출혈, brachial palsy, 두개골골절 등이 있었다. 8) 조산기사망율은 초산부에서 111.9, 경산부에서 265.9, 전체적으로는 200.0이다. 9) 모체의 사망은 1예도 없었다. It has been well known that the breech presintation is the most frequent abnormal presentation and has inherent obstetric problems especially on the fetal and maternal morbidity and complications in primigravida. From Jaruary, 1950 to December, 1968, there were 377 cases of breech delivery in the Dept. of Obstetrics and Gynecology, National Medical Center. The authors attempted ten years clinical survey on the above materials consisted of breech delivery of singletons of nullipara and multipara, and twins. The results obtained were as follows : 1) The incidence of breech delivery was 2.9% in singlitons and 3.8% in all deliveries of singlitons and twins. 2) The incidence based on the parity was 3.1% or over in nullipara and 2.1% or over in multipara. Age distribution was concentrated on the ages between 26-30. The youngest was 20 and the oldest was 53. 3) As to the gestational weeks and baby weight, 71.9% was 38 weeks or over and 72.6% was 2,500 gm or over, respectively. 4) Regarding the type of breech presentation the most common was frank breech (76 cases) and the others were in incomplete (66 cases) and complete breech (20 cases). 5) The mode of delivery in orders were partial extraction(65.7%), cesarean section (13.6%), spontaneous delivery (11.2%0, total extraction (6.2%0 and the other (3.3%). 6) As to the duration of the labor, 78% of nullipara and 84% of multipara were completed within 24 hours in vaginal delivery. 7) The maternal and fetal complications were in orders of toxemias of pregnancy (66 cases), early rupture of membranes (26 cases), cord prolapse (13 cases), contracted pelvis (12 cases) and the remainders were placenta previa, abruptio placentae, prolonged labor, retained placenta and postpartum bleeding. 8) The perinatal mortality was 111.9 in nullipara, 265.9 in, multipara and 200.0 in all. 9) No maternal death was encountered.

복강경불임술의 임상적 관찰 ( 제1호 )

박인재(IS Park),김현준(HC Kim),박성구(SK Park),송인철(IC Song) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.3

저자는 1974년 5월 1일 부터 11월 30일까지 국립의료원 산부인과를 방문한 불임수술희망자중 복강경불임술을 시행한 147명에 대하여 조사분석하여 다음과 같은 결과를 얻었다. 1) 연령분포는 31-35세군이 79례(53.7%)로 수위이었고 26-30세군이 37례(25.2%)로 차위이었다. 11) 합병증으로 난간막출혈 9례, 그리고 피하기종이 3례있었다. One hundred forty seven cases of Laparoscopic tubal sterilization wre performed by means of fulguration and resection under mostly general anesthesia or local anethesia in a small number of caes during 19 months period from May 1 1973 to Nov, 30 1974. One incision and three burn technique were applied in this study. Age distribution showed the highest incidence in the age group of 31 to 35 years and average age was 32.6 years with the youngest age 19 years and the oldest 42. The number of children at Laparoscopic sterilization reported 3 kid in 40.4% of all cases and 2 kids in 23.8% respectively. The interval between the last delivery and Laparoscopic sterilization ranged 1 to 3 years in 45.6% of all cases. General anesthesia was used for 126 caese (82.7%) local anesthesia for 18 cases (12.3%) and combined local and general anesthesia for 3 cases (2.0%) Three to five liters of CO2 gas consumed for pneumoperationeum in more than half of all cases. It took less than 30 minutes to complete Laparoscopic tubal sterilization in 79.0% of all cases. Hospital stay required less than 24 hours in 80.2% of all case mostly in case of general anesthesia. Twelve cases (8.2%) of previous appendectomy were submitted to Laparoscopic tubal sterilization without considerable technical difficulty. Other episodes of previous Laparotomy were excluded for the indication of Laparoscopic tubal sterilization Laparoscopic tubal sterilization coincidence with artificiall abortion were carried out in 63 cases As the complications 9 cases of mesosalphingeal hemorrhage 7 cases of tubal hemorrhage and 3 cases of subcutaneous emphysema were encountered, but no intensive medical care was required in any cases.

산과영역에 있어서 지속성 경막외마취에 관한 임상적 고찰

조성진(SJ Cho),주경란(KR Joo),박찬용(CY Park),김경태(KT Kim),송인철(IC Song),주영철(YC Joo),박인서(IS Park) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.5

국립의료원 산부인과에서 1978년 1월 초부터 1978년 8월 말까지 산과적 합병증이 없었던 산모 100명을 정상 산모군 50예와 경막외마취 시행군 50예로 나누어 비교 관찰하여 다음과 같은 결론을 얻었다. 1. 산모의 분만회수별 분포는 대조군에서 초산부 26예, 경산부 24예이었고, 경막외마취 시행군에서는 초산부 30예, 경산부 20예였다. 연령별 분포는 각각 공히 26∼30세군이 제일 많은 분포이었다. 2. 분만 제1기의 기간은 초산부에서는 자궁개대가 5cm 이하인 경우 및 5∼10cm인 경우 대조군은 각각 460.5±36.18분, 165.9±19.67분이었고, 경막외마취 시행군에서는 각각 480.3±32.43분, 158.5±18.39분이었다. 경산부에서는 대조군의 경우 각각 228.8±23.46분, 77.5±13.24분, 경막외마취 시행군의 경우 각 216.3±24.17분, 104.0±14.31분을 보여 초산부에서는 경막의 마취 사용할 때 분만기간이 짧아지는 경향을 보였다. 3. 분만 제2기의 기간은 초산부에서 대조군이 48.0±6.62분, 경막외마취 시행군이 96.2±13.15분이었고 경산부에서는 각각 20.1±1.79분, 54.8±3.73분을 보여 분만 제2기의 기간은 경막외마취 시행시 지연되는 경향이었다. 4. 객관적 및 주관적 점수를 합하여 측정한 경막외마취의 효과는 0∼4(Good)군이 42예(84.0%), 5∼8(Fair)군이 7예(14.0%), 9∼12(Poor)군이 1예(2.0%)로 경막외마취 사용할 때 무통분만의 큰 효과를 볼 수 있었다. 5. 태아절박증은 대조군에서 50예 중 2예(4.0%), 경막외마취 시행군에서 50예 중 1예(2.0%)로 유의한 차이가 없었고, 1분 Apgar 평점은 7-10점군이 대조군 50예 중 47예, 경막외마취 시행군 50예 중 48예이었고 5분 Apgar평점은 7-10점군이 대조군 50예 중 49예, 경막외마취 시행군 50예 전례로서 경막외마취가 태아에 나쁜 영향을 미치지 않았다. 6. 분만형태는 대조군에서는 정상분만 42예(84.0%), 흡인분만 5예(10.0%), 제왕절개술 3예(6.0%)이었고, 경막외마취 시행군에서는 각각 25예(50.0%), 23예(46.0%), 2예(4.0%)를 보여 경막외마취 시행시 흡인분만의 빈도가 4.6배 증가하였다. 7. 경막외마취 시행 후 진통효과는 평균 12.3±5.4분에 나타났으며, 약 반수(48.0%)에서 11∼15분 사이에 진통효과가 나타났다. 8. 총 lidocaine사용량은 분만 제1기에 144.3±21.7mg, 분만 제2기에 120±8.3mg이었고, 일회 투여량에 의한 진통효과의 지속기간은 각각 52.4±9.4분, 66.2±3.5분이었다. 9. 분만소요기간은 태아의 체중 Clinical research was made to clarify the effect of the continuous epidural analgesia on labor in 50 cases of uncomplicated pregnancies in comparison with 50 cases of control group who did not undergo analgesia during labor at the Department of Obstetrics and Gynecology from January to August, 1978. The results were as follows: 1. In the control group, 26 women were primipara and 24 women were multipara, while 30 women were primipara and 20 women were multipara who underwent labor and delivery under epidural analgesia. The most common maternal age ranged from 26 to 30 in both groups. 2. Duration of the first stage of labor was measured subdividely according to the extent of cervical dilatation, which revealed shortening of labor in primipara under epidural anesthesia. It took 460±36.18 minutes until cervix dilated to 5cm and 165±19.67 minutes over 5cm to full dilatation in the control primipara. It was 480±32.43 and 158±18.39 minutes in primipara under epidural anesthesia, respectively. In the multipara, it took 228.8±23.46 minutes and 77.5±13.24 minutes in the control group and 216.3±24.17 and 104±14.31 minutes in the anesthesized group. 3. Duration of the second stage of labor was lengthened in anesthetic group. While it took 48.0±4.62 minutes in the control primipara and 96.2±13.15 minutes in the women under anesthesia, it was 20.1±1.79 minutes in the control multipara and 54.8±3.73 minutes in the multipara under the epidural anesthesia. 4. Subjective and objective scoring were applied to evaluate the extent of pain relief in anesthetic group: 42 women(84.0%) had good score(0-4), 7(14.0%) fair score(5-8) and only one(2.0%) poor score(9-12). 5. Fetal distress occured in 2 cases in control group and 1 case in the anesthetic group. 47 and 48 cases had good 1 minutes Apgar score(7-10) in control group and anesthetic group, respectively. 49 cases of the control group and all cases of anesthetic group had 5 minutes Apgar score over 7, which showed no significant adverse effects of epidural

임신중 심장질환의 임상적 고찰 ( 제II보 )

박인서(IS Park),조인제(IJ Cho),배평원(PW Bae),송인철(IC Song),주창남(CN Joo),정규봉(KB Jung),이학중(HJ Lee) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.3

1. The incidence of heart disease in pregnancy was 0.37%. 2. Mitral stenosis was predominated (29.4%) 3. The age distribution was predominated in the age 26-30 (41.1%) 4. Heart disease occurred mainly in the primigravida (32.4%) 5. Functional capacity of the heart was mainly in class I. 6. The chief comlaints were dyspnea, edema and palpitation. 7. Spontaneous vaginal delivery was undertaken in 19 cases (52.8%) and instrumental delivery was in 7 cases (30.5%) 8. The incidence of prematurity was 30.6%. 9. Seventy five percent of cases was complicated among which 30.8% cases was complicated by cardiac failure and 17.3% was complicated by toxemias of pregnancy with heart failure. 10. Digitalization was undertaken in 29 cases (85.3%) 11. No maternal mortality was noted in this study.