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- 저자 : 주응식(Eung Sik Ju) (검색결과 3 건)
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GnRH Agonist에 의한 자궁근종의 조직병리학적 변화
주응식(Eung Sik Ju),김일규(Il Gyu Kim),오영은(Young Eun Oh),조영래(Young Lae Cho) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2
목적 : goserelin으로 치료한 자궁근종의 축소기전을 병리학적 관점에서 알아보기 위해 본 연구를 시행하였다. 연구방법 : 자궁근종으로 진단된 환자에서 수술전 goserelin을 투여한 24예와 goserelin을 투여하지 않은 자궁근종 26예에서 병리학적 소견을 비교하였다. 각각의 자궁근종에서 hyalinization, hydropic change, lymphocytic infiltrate, nuclear atypia 그리고, hypercellularity를 비교하였으며, 검정결과는 p-value 가 0.05 미만인 경우를 통계학적으로 유의하다고 판정하였다. 결과 : Hyaline degeneration과 hydropic change는 goserelin치료군에서 유의하게 많았으나 lymphocyte infiltrate, nuclear atypia, hypercellularity는 유의한 차이가 없었다. 전자현미경적 소견은 치료받은 근육세포에서 세포내 소기관의 손상으로 형성된 큰 세포질 공포, 미토콘드리아의 종창, 전자밀도가 높은, 많은 수의 이차리소솜을 나타내었다. 결론 : goserelin 치료시 자궁근종의 빠른 축소는 근육세포의 hydropic change와 hyaline degeneration으로 인한 것이며 그외의 다른 퇴행성 변화도 관여할 것으로 사료된다. Objective : To define the pathologic changes underlying the mechanism of shrinkage of uterine leimyoma in patients treated with goserelin. Methods : Retrospective evaluation of pathologic changes seen in leiomyoma removed by hysterectomy or myomectomy in treated and untreated patients was done. Microscopic review of all cases was performed without knowledge of the therapeutic history. Each leiomyoma was assessed for hyalinization, hydropic change, lymphocytic infiltrate, nuclear atypia, and hypercellularity. Results : Hyaline degeneration and hydropic changes were found significantly more frequent in patient treated with goserelin (P <0.05). The differences between treated and untreated groups in lymphocytic infiltrate, nuclear atypia, and hypercellularity were not statistically significant. The ultrastructural features of variable numbers of the treated muscle cells showed large vacuole, marked swelling of mitochondria, and compound lysosomal structures presumed to have been formed from damaged intracellular organelles. Conclusion : It appears that the rapid decrease in size of the leiomyoma treated with goserein occurs as the smooth muscle tissue undergoes hydropic change and hyaline degeneration. It seems that other cellular degenerative changes may be involved in the mechanism shrinkage of uterine leiomyoma.
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주응식(Eung Sik Ju),김일규(Il Gyu Kim),오영은(Young Eun Oh),이현정(Hyun Jung Lee),이택후(Taek Hu Lee),전상식(Sang Sik Chun) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2
본원 산부인과에서 최근 10년간 각종 질환으로 수술적 자궁경술을 시행받은 163명을 분석하여 이들 중에서 불임을 주소로하는 자궁내 유착 환자 98명을 대상으로 수술 후의 reproductive outcome을 조사 분석하였다. 자궁내 유착의 정도는 미국불임학회의 기준을 따라 분류하였고 분류에 의하면 자궁내 유착 환자 98명은 각각 mild 29.6%, moderate 43.9%, severe 26.5%의 빈도를 보였다. 자궁내 유착 경우 선행 원인으로는 인공 혹은 자연 임신중절이 대부분을 차지하고 그외에 제왕절개술, 포도상 기태, 골반결핵 등이 있었으나 원인을 정확히 밝힐 수 없는 경우도 일부 있었다. 유착제거술 후 임신율은 전체로는 53.3%, mild, moderate, severe의 경우 각각 84.6%, 45.0%, 33.3%의 임신율을 보였다. 환자에 따라서는 자궁내막증이나 난관폐쇄 등 다른 불임인자를 포함하는 경우도 있어 그 결과의 분석이 어렵고 또한 많은 환자가 추적에서 이탈되어 45.9%(45/98명)만이 추적 조사가 가능하였다. 추적기간은 1.0년 이상을 대상으로 하였고 최장 8.8년간 추적이 가능하였다. 합병증으로는 자궁천공 5례, 호흡곤란 내지 폐부종 2례, 출혈과 방광손상 각각 1례 등으로 나타났다. One hundred sixty three patients were hysteroscoped for various reasons at our department over 10 year period. Ninety eight patients out of 163 who were diagnosed and treated for their intrauterine adhesions(IUAs) by hysteroscopy were analysed retrospectively. Patients were classified as having mild, moderate or severe stage of IUAs according to American Fertility Society classification. Twenty nine patients(29.6%) had mild IUAs, 43 patients (43.9%) had moderate IUAs, and 26 patients(26.5%) were classified as having severe stage IUAs. The predisposing causal factors of IUAs were abortion, full-term delivery, H. mole, pelvic tuberculosis and myomectomy in order of frequency but in eight cases no cause was identified. After hysteroscopic surgery, although high rate(83.9%) of restoration of normal menstruation was attained but term pregnancy rate was only 53.3% and rather high rate (32%) of preterm or abortion were identified and those pregnancy outcomes were correlated with the stage of IUAs. Complications of surgery consisted of uterine or bladder perforation, pulmonary edema and hemorrhage.
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이동영,박철민,이윤순,조영래,주응식,박일수 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.3
Microinvasive carcinoma of the uterine cervix(Stage Ia) is the earliest stage of squamous carcinoma. The transition from preinvasive to invasive disease is a crucial juncture in the development of cervical cancer. The clinical experience that microinvasive lesions carry a better prognosis justifies a separate diagnostic category. To investigate the clinical and pathological aspects of microinvasive cervical carcinoma, a retrospective study was made on 84 cases, histologically reconfirmed surgical specimens, which had been treated during the period from January, 1985 to December, 1996 at Department of Obstetrics and Gynecology, Kyung-pook National University Hospital. We defined microinvasive carcinoma as stromal invasion not exceeding a depth of Smm from the base of the epithelium presented by FIGO in 1985. The results obtained were as follows; 1. Mean age of 84 patients was 46.9 year old, all were parous women but not 1 patients. 60 cases(71.4%) belonged to stage Ia1 and 24 cases(28,6%) to stage Ia2. 2. Chief complaints were postcoital spotting and leukorrhea. 3. The corresponding rate of Pap. smear to histologic diagnosis was approximately 29.8%. However correponding rate within one histologic grade was about 33.3%. 4. According to the colposcopic examination, 26.4% of cases revealed suspected abnormal findings suggesting invasive lesion. 5. As to the reports of punch biopsy, 55.1% of cases showed microinvasive and/or invasive lesion. With additional diagnostic conization of cervix, the preoperative diagnosis were correct in 72%. 6. Operation performed were simple hysterectomy, extrafascial hysterectomy or modified radical hysterectomy with both pelvic LN dissection. Simple hysterectomy was most commonly performed. 7. Post-treatment complications were developed in 73.9% of patients who were done with modified radical hysterectomy with both pelvic LN dissection and bladder dysfunction was developed in 50% of the patients.
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