난관복원수술 후 임신율과 임신에 영향을 미치는 인자에 관한 연구―1008 예에 대한 임상적 고찰―

이위현,윤태기,차선희,성혜리,이우식,박원식,이정노 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

난관복원수술 후에 임신 결과에 영향을 줄 수 있는 예후인자들을 살펴보고자 1989년 1월부터 1994년 4월까지 5년 3개월간 미세난관복원수술을 시행받은 1008예를 검토하여, 그 중 1년 이상 추적 관찰이 가능했던 764예를 대상으로 다음과 같은 결과를 얻었다. 1. 난관복원술을 받게 된 이유로서는 아이를 더 가지려는 경우(44.5%), 자녀의 잃음(36.8%), 재혼(18.7 %) 등이 주 원인이었다. 2. 대상 환자의 평균 연령은 34.1세였으며, 그들 중 복강경 전기소작으로 불임시술을 받았던 경우가 51.4% 였다. 3. 난관문합시술의 가장 흔한 부위는 협부-팽대부 (66.8%)였으며, 다음으로 협부-협부, 자궁각-팽대부의 순 이었다. 4. 복원수술 후의 잔여 난관의 길이는 71.5%에서 4.1cm 이상을 보였다. 5. 복원수술 후의 임신율은 75.0%를 보였고, 그 임신의 결과 만삭분만이 80.5%, 분만안된 경우가 11.2%, 조산 0.3%, 자궁내 태아 사망 0.3%, 자연유산 4.9%, 그리고 자궁외임신이 2.9% 였다. 6. 기왕의 불임수술 방법과 난관문합시술의 위치 그리고 술후의 잔여 난관의 길이에 따른 임신율의 유의한 차이는 없었다. 7. 수술 후 연령별 임신율은 40세 이상에서 통계적으로 유의한 감소를 보였다(p=0.0001). 8. 수술 후 임신까지의 평균 기간은 4.8개월이었으며, 4 cm를 기준으로 하였을 때 난관의 길이에 따른 임신율의 차이는 없었다. 결론적으로, 본 연구에서는 환자의 연령이 임신에 영향을 미치는 중요한 요인으로 사료된다. Objective: The purpose of this study is to evaluate the factors influencing the pregnancy outcomes of microsurgical tubal reanastomosis. Study design: During 64 months from Jan. 1989 to Apr. 1994, 1008 cases of microsurgical tubal reversal were performed and 764 cases of them were followed up and analysed retrospectively for more than 1 year postoperatively. Results: The overall pregnancy rate was 75.0%, ectopic pregnancy was 2.7%(not involved in overall pregnancy rate) and spontaneous abortion was 4.9%. No statistical differences were found in pregnancy rates according to the method of previous sterilization, the site of tubal reanastomosis and postoperative tubal length. The tubal length did not influence the mean interval from operation to pregnancy and pregnancy rate. But the pregnancy rate decrease was statistically significant at the age of over fourty. Conclusions: The age was the only factor influencing the pregnancy outcomes of microsurgical reanastomosis of tubal sterilization.

동제 자궁내 피임장치인 Gravigard 일반형과 소형의 삽입에 관한 임상연구

이위현(WH Lee),강희원(HW Kang),황동훈(DH Hwang),정순오(SO Chung),곽현모(HM Kwak) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.6

자궁내 피임장치 삽입 대상자가 적어서 통제적인 의 의를 언급하기는 어렵지만 이상과 같이 동제 자궁내 피임장치 Gravigard의 일반형과 소형을 삽입하여 다음 과 같은 결과를 얻었다. 1. 총 사용 개월수는 일반형군이 208개월, 소형군이 135개월, 합계 343개월이었다. 2. 자궁내 피임장치 삽입자의 대부분이 25∼29세군 (71.7%)의 연령분포였고, 평균연령은 23.9세였다. 3. 자궁크기는 대부분(91.7%)이 자궁내강 깊이 6.0 ∼7.0cm이었고, 일반형군은 6.6cm, 소형군이 6.1cm 의 평균치를 나타냈다. 4. 부작용은 일반형군에서 53.3%, 소형군에서 56.7 %, 평균 55%였다. 5. 자궁내 피임장치의 배출율은 일반형군에서 26.7 %, 소형군에서 16.7%, 평균 21.7%였다. 6. 자궁내 피임장치의 사용중단율은 일반형군에서 46.7%, 소형군에서 63.3%, 평균 55%였다. 7. 임신은 총 60예중 1예에서 있었으며, 6.0cm의 자궁내강을 가진 소형군에서 발생하였다. 8. 자궁내강 깊이의 대소에 따른 부작용, 자연배 출, 사용중단율은 일반형과 소형군에서 별 차이가 없 었다. 본 저자의 연구 결과와 Rees(1979)의 보고를 통하 여 소형의 Gravigard를 임신경험이 없거나, 작은 크기 의 자궁을 가진 여성에게 사용하는 것이 좋고, 아울러 정상크기의 자궁을 가진 여성에게도 일반적으로 사용 하여도 좋을 것이라는 가정을 세울 수 있겠으나, 앞으 로 좀 더 많은 대상자를 취급하여 연구 관찰하여야 할 것으로 사료된다. We conducted comparative clinical study to evaluate the acceptability and effici-ency of the small frame intrauterine deⅵce by using the intrauterine copper contr- aceptive, regular and small Graⅵgard. Regular and small Graⅵgards were inserted into 30 acceptors in each at Yonsei University Family Planning Clinic from January to June 1978. We followed up abo- ut the side effects expulsion, termination rates of the lUD after insertion for 18 months. And the results were as follows. 1. The total months of use were 208 in regular Graⅵgard group, 135 in small Graⅵgard group, total 343. 2. ln most of acceptors (71.7%) were in age group of 25~29 years, and the average of age was 23.9 years. 3. The uterine depth was 6.0~7.0cm in 91.7% of cases. 4. The side effects were seen in 53.3% of regular Graⅵgard group, 56.7% of SMall Graⅵgard group, average 55%. 5. The expulsion rates were 26.7% in regular Graⅵgard group, 16.7% in small Graⅵgard group, average 21.7%. 6. The termination rates were 46.7% in regular Graⅵgard group, 63.3% in small Gravigard group, average 55%. ,7. Only one pregnancy was developed in small Graⅵgard group. 8.There were no eⅵdence of significant differences of the side effects, expulsion termination rates of small Graⅵgard from regular Gravigard to uterine depth.

정상 임산부에 있어서 신생아 생리적 황달 발생과 모체 혈청 및 양수내 AFP치에 관한 연구

이위현 ( We Hyun Lee ),양영호 ( Young Ho Yang ),조진호 ( Jin Ho Cho ),이윤호 ( Yoon Ho Lee ),박금자 ( Kum Ja Park ) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.7

This study was conducted to see the AFP levels in serum and amniotic fluid of normal pregnant women at or near term (37~42 weeks), and their significance as the possible index of the fetal liver maturity. Sixty seven paired serum and amniotic fluid were obtained from normal pregnant women between 37 and 42 weeks of gestation. For the determination of the levels of AFP in maternal serum and amniotic fluid, radioimmunoassay had been perfor-med and the following results were obtained. 1. Neonatal physiologic jaundice developed in 13 cases (19.4%) from 67 cases. 2. AFP levels of maternal serum and amniotic fluid significantly decreased prog-ressively to later pregnancy, and their equations to the weeks of gestation in normal and physiologic jaundice group were as follows: (Y=value of AFP, X=weaks of gestation) In maternal serum: a. normal group: Y=733.24-15.21X (R= -0.5051, t=4.220., d.f.=52, p<0.05) b. physiologic jaundice group: Y=1,035.72~20.57X (R=-0.5703, t=2.303, d.f.=11, p<0.05) In amniotic fluid: a. normal group: Y=1,095, 23-21.36X (R=-0.6310, y=5.865, d.f.=52, p<0.05) b. physiologic jaundice groups: Y=1,044.13-17.28X (R=-0.7632, t=2.483, d.f.=11, P<0.05) 3. AFP levels were significantly higher in physiologic jaundice group than normal group (p<0.01) and their mean levels of AFP in maternal serum and amniotic fluid were as follows: In maternal serum: a. normal group: 128.61±41.51 ng/ml b. physiologic jaundice group: 230.15±48.51 ng/ml (t=7.2595, d.f.=65, p<0.01) In amniotic fluid: a. normal group: 247.98±46.46 ng/ml b. physiologic jaundice group: 367.46±30.45 ng/ml (t=8.8010, d.f.=65, p<(0.01) 4. There was no correlation between neonatal physiologic jaundice and fetal body weight (p>0.05). 5. There was no correlation of mean AFP level to parity, sex and body weight of fetus (p>0.05).

복강경하 난관복원수술 후 임신율에 관한 임상연구

이위현(Wee Hyun Lee),차선희(Sun Hee Cha),이미화(Mee Hwa Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. Method; During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+-4.3 years(mean+-SD; range 26 to 47 years). Result: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+-35.5 minutes) than for laparotomy(159.7+-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+-2.3 days for laparoscopy, 6.1+-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. Conclusion: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.

임상적 악성융모종양의 예후인자가 치료결과에 미치는 영향

조진호,박찬규,이위현,박금자,노성일 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.6

포스타 : 산과학 ; 자궁내 흉수천자로 산전 진단된 선천성 유미흉 1예

이상희,이은혜,이위현,안재영,차경섭 대한산부인과학회 1998 대한산부인과학회 학술대회 Vol.82 No.-

골반 장기 탈출 환자에서 실리콘 환 페사리 이용에 대한 임상적 고찰

김현철,선우태원,이위현 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

목적: 본 연구는 골반 장기 탈출증 환자의 치료에 있어서 수술이 부적당한 경우 대안으로 실리콘 환 페사리 사용에 대한 효용성 및 안전성, 그리고 순응도에 대하여 알아보고자 시행되었다. 연구방법 : 1997년 1월부터 1998년 12월까지 골반 장기 탈출증으로 본원에 내원한 환자중 수술에 부적합하거나 수술을 거부한 환자 58명을 대상으로 순응도, 합병증, 자궁유무와의 관계등에 대하여 조사하였고 페사리삽입 및 착용유지실패군에 대해서는 따로 분석하였다. 결과 : 58명의 대상환자중 8명이 중도에 포기하여 13.7%의 탈락율을 보였고 29명(50%)에서 합병증을 보였다. 페사리실패의 주된 원인은 질점막궤양(4예)과 페사리의 탈출(3예)으로 나타났다. 페사리의 합병증 및 문제점은 다양하게 나타났는데 페사리의 탈출(10예), 질점막미란 및 궤양(9예), 질내감염(6예)등이었다. 자궁적출술을 시행한군과 자궁이 있는군사이에서는 페사리실패율 및 합병증발현율에서 별다른 차이가 나타나지 않았다. 결론 : 골반내 장기 탈출 환자중 수술에 부적합한 환자에 있어서 페사리는 간편하고 안전하며 효과적인 대안이 될 수 있을것이라 생각되며 추후 이에 대한 더 많은 연구가 필요할 것으로 생각된다. Objective : To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. Methods : This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. Results : Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. Conclusion: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.

쌍태아임신에서 치사성 이형성증 1 예

이유미,차경섭,이위현,김종욱,권계원,최윤정 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

We present male monozygotic twin with thanatophoric dysplasia type I concordant for long bone abnormalities and narrow thorax without cloverleaf skull. The diagnosis was made at 21weeks 3days` gestation. Prenatal diagnosis and postmortem examination showed severe micromelia, bowed long bones with "telephone-receiver" shapes and narrow thorax with short ribs in both twin. Finally it was confirmed by radiologic and pathologic examinations. The case will be presented in more details with a brief review of literature.

복강경하의 흔적자궁 임신진단 및 처치 1 례

김재욱,조동제,이위현,차선희,이미화,이경술,원종건,강승룡 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

In this presentation, we describe a case of unruptured rudimentary uterine horn preg-nancy. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudmentary uterine horn, and then some articles concerned to this subject are reviewed briefly in order to discuss relevant method of diagnosis, treatment, and clinical characteristics.

자궁강내 병변진단에 있어서 자궁난관조영술 , 자궁경검사 , 경질초음파 자궁조영술의 진단적 정확성에 대한 비교 연구

이유미,차경섭,이위현,차선희,최정교 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows: 1. The patients` ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows:septated uterus(n=2), intrauterine adhesion:IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.