제 77 차 춘계학술대회 : 논문초록 ( 부인과학 ) ; 자궁경부암의 광범위 자궁적출술 후 합병증 발생에 대한 임상적 고찰

정선안,이형근,이귀세라,김사진,김은중,한구택,남궁성은,송승규,이헌영,김승조,김수평 대한산부인과학회 1996 춘계학술대회 Vol.- No.-

자궁경부암의 광범위 자궁적축술 후 합병증 발생에 대한 임상적 고찰

정선안,이형근,이귀세라,김사진,김은중,한구택,남궁성은,송승규,이헌영,김승조,김수평 대한산부인과학회 1996 대한산부인과학회 학술대회 Vol.77 No.-

접촉성 Neodymium: Yttrium Aluminum Garnet(Nd: YAG) 레이저를 이용한 토끼 자궁각문합술

전준연 ( Joon Yeon Jun ),정선안 ( Sun An Jung ),송영훈 ( Young Hun Song ),고영미 ( Young Me Koh ),김장흡 ( Jang Heub Kim ),김진홍 ( Jin Hong Kim ),이진우 ( Jin Woo Lee ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

This study was aimed to determine the feasibility of using the Nd: YAG laser with a synthetic sapphire contact tip to weld the transected rabbit uterine horns and to compare the effects of conventional microsurgical anastomosis with Nd: YAG laser welding of the uterine horns. Forty -eight rabbit uterine horns were transected and subjected to microsurgical anastomosis(control group, 16 uterine horns) or laser welding(laser group, 32 uterine horns). The laser group was divided into 3 subgroups based on the different laser power levels; 4, 5, and 6 watts level were applied to 8, 8, and 16 uterine horns, respectively. The surgical time of each procedure were recorded. Four weeks later, a laparotomy was performed to determined adhesion formation and uterine horn patency, and a histologic examination was done of the anastomosis sites. The results were as follows: 1. In the case of a unilateral uterine horn anastomosis, control group required significantly longer operation time(30.2±2.1 minutes) than 4, 5, or 6 watts laser group(9.3 ± 1.5, 8.2 ± 1.3, 8.5 ± 0.7 minutes, respectively). 2. Laser group produced slightly less adhesion(adhesion score, 1.09±0.78) than control group(l.44 ±0.96), but there was no significant difference. 3. One of 16 uterine horns in control group(6.3%) and one of 32 in laser group(3.l%) were not patent by chromopertubation using methylene blue. The leakage of methylene blue at the anastomosis sites were 6.3% in control group and 12.5% in laser group. Thus, the patency rate(without occlusion and leakage) were 87.5% in control group and 84.4% in laser group, whose result does not show significant difference. Meanwhile, laser group with 6 watts power level showed 1000%patency rate. 4. There were fewer constrictions at the anastomosis sites in laser group than control group in some rabbits. In other rabbits, the uterine homs were equally smooth. Microscopically, well-healed mucosal layer and minimal inflammation at the anastomosis aites were observed in laser group, but there were irregular mucosal layer, thin and mildly disrupted muscularis layer with some fibrosis, moderate inflammation, and foreign body granulomas were found in control group. 5. The contact Nd: YAG laser with a synthetic sapphire tip was found to be able to weld the transected rabbit uterine homs successfully. The most appropriate power level was 6 watts in the experiment. In conclusion, the patency rates were similar between the control and Nd: YAG laser group. But less operation time and simple manipulation of Nd: YAG laser might enable clinicians to get a better results on the tubal reconstruction.

한국 여성의 자궁경부이형증 환자에 있어서 Retinoic Acid 투여 후의 HPV Titrationd의 변화

김승조,남궁성은,안웅식,이형근,정선안,김진범,공기환,안상복 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Retinoids have been recognized as a family of molecules capable of profound impact on many biologic functons, also known to possess antiproliferative, differentiative, and immunomodulatory properties. However, only recently have laboratory and precoinical and clinical oncology reseatch made this knowledge immediately relevant to the problem of malignancy. Cervical cancer is thr second most common malignancy in women worldwide and remains a significant health problem in women. While the natural history is well known, little is known of the pathobiology of cervical carcinogenesis, prevention of cervical cancer and its precursors are impprtant objectives. To assess the effect of 13-cis-retinoic acid(13-CRA) in the rteatment of 13 chronic cervicitis and 52 cervical intraepithelial neoplasia, we examined lower and high risk Human Papilloma Virus(HPV) titration(using Hybrid Capture system) and colposcopic and cervicographic examination before and after rteatment with 13-CRA 1㎎/㎏ for 4 to 12 weeks. The following results were obtainted : 1. The age distributon of patients was between 23 years and 64 year, average 36.6 years old. 2. Histology revealed the chronic cervicitis 13 cases, mild dysplasia 18 cases, moderate dysplasia 18 cases and severe dysplasia 16 cases, total 65 cases. 3. Among these groups the expression rates of high risk Human Papilloma Virus(HPV 16, 18) were 9 of 13 cases(69%) in chronic cervictis, 7 of 18 cases(39%) in mild dysplasia, 9 of 18 cases(50%) in moderate dysplasia and 12 of 16 cases(75%) in severe dysplasia, overall expression rate was 37 of 65 cases(57%) 4. After treatment, decreasing changes of HPV titration(high risk)vy hybrid capture system were 6 of 9 cases(66%) of chronic cervictis, 3 of 7 cases(43%) of mild dysplasia, 7 or 9 cases(77%) of moderate dysplasia, 8 of 12 cases(75%) of severe dysplasia,overall decreasing rate was 25 of 41 cases(61%). From this stucy, high risk HPV titration were decreased after treatment winh 13-CRA in prtients with cervical intrapithelial neoplasia, it revealed some potentiality to interrupt multistep caricnogenesis by possibly down regulation of gene product(E6, E7) produced by HPV infection.

자궁경부암의 광범위 자궁적출술 후 합병증 발생에 대한 임상적 고찰

김승조,송승규,이헌영,남궁성은,김수평,김은중,김사진,이귀세라,정선안 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

From March 1, 1991 through December 31, 1994, 87 patients with cervical carcinoma were treated with radical hysterectomy in the Department of Obstetrics and Gynecology, Catholic university Medical College, Holy Family Hospital. We studied about the duration of Hemovac insertion, the amount of Hemovac drainage, the duration of indwelling foley catheter, the amount of intraoperative or postoperative trasfusion, and postoperative complications among 87 patients who were operated at Holy Family Hospital. The results were as follows; 1. The mean age of patients was 50.5 years (range: 30 years-71 years). Patients in stage Ib were 49.5%. 2. Only radical hysterectomy without chemotheraphy or radiation theraphy was carried out 84.6% in stage Ia, 48.8% in stage Ib, 33.3% in stage Iia and 21.0% in stage IIb. 3. The mean duration of Hemovac insertion was 8.9 days(range: 2days-22days) and the mena amount of Hemovac drainage was 191.7 cc(range: 19.2 cc-1070.7 cc) The Hemovac was removed out when the drainage amount was about 70-80 cc. 4. The mean duration of indwelling foley catheter was 25.5 days (range; 14days-97days). 5. The mean amount of intraoperative or postoperative transfusion was 4.7 pints(range: 1pint-11 pints). 6. Among the postoperative complications, urinary tract infection was 18.4%, wound infection was 4.6%, stump abscess was 3.5%, postoperative bleeding was 1.2%, recurrent cervical carcinoma was 5.8%, and obturator nerve palsy, ureterovaginal and rectovaginal fistula were respectively 1 case.

절제수술로 치료한 자궁경부 상피내암과 미세침윤암에서 세포진과 조직진의 비교평가

윤수철 ( Soo Cheol Yoon ),공기환 ( Gi Hwan Gong ),정선안 ( Sun An Jung ),최영석 ( Young Seuk Choi ),유기성 ( Ki Sung Ryu ),한구택 ( Ku Taek Han ),나종구 ( Jong Gu Rha ),이헌영 ( Hun Young Lee ),김수평 ( Soo Pyung Kim ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

We evaluated 221 patients who were preoperatively diognosed as carcinoma in situ(CIS) and microinvasive carcinoma(MIC) from Jan. 1988 to Dec. 1995 at the Department of Obstetrics and Gynecology, St. Mary`s hospital, Catholic University Medical College. The data gained from 221 patients with sucessful tollow-up were thoroughly reviewed to determine the proper diagnosis and treatment model. They were treated by conization, total abdominal hysterectomy or type II hysterectomy. The final diagnoses of 127 patients who got one cytologic diagnosis at local clinic or our hospital were 80 CIS, 45 MIC and 2 mvasive carcinomas. In cytology, 47 case(58.8 %) of 80 CIS showed abnormal findings as class III(30 %), IV(22.5 %) and V(6.3 %). In 45 MIC, 33(73.3 %) cases showed abnormal finding as class III(35.6 %), IV(28.9 %) and V(8.9 %). 94 patients who got cytology twice at the local clinic or our department were finally diagnosed as 72 CIS and 22 MIC. By repeating cytology, we could reduce false positive rate, 12.5 % in CIS and 4.5 % in MIC, however repeat cytology had little diagnostic value. In comparison of colposcopy guided biopsy(CGB) to non-colposcopic blind biopsy, CGB was more predictive. In CIS, the accurate diaganosis rates were 77.6 %(52/67) in blind biopsy and 88.8 %(95/124) in CGB. In MIC, the accuracies were 71.8%(28/39) in blind biopsy and 100 %(33/33) in CGB. So colposcopic evaluation with optional conization was essential for pooper diagnosis and treatment. There were unfavorable histologic findings: vaginal extension(n=4; 1.8 %), lymphovascular space involvement(n=4; 1.8 %), perineural invasion(n=1; 0.5 %) and occult invasive cancer(n=2; 1.8 %). So conservative treatment and local destructive therapy were potentially dangerous in CIS and MIC and should be performed after precise evaluation in selected cases. For proper diagnosis and treatment, cytologic evaluation had limited clinical values and CGB with optional conization was needed.