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박성호 ( Sung Ho Park ),나연식 ( Yon Sik Na ),정지윤 ( Ji Yoon Jung ),양성천 ( Seong Cheon Yang ),최수란 ( Su Ran Choi ),김성주 ( Sung Joo Kim ),장봉림 ( Pong Rheem Jang ),권용일 ( Yong Il Kwon ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2
목적: 자궁외임신에 대한 임상 및 역학적 특성을 분석하고 그 조기진단과 적정한 치료법을 확인하기 위해 본 연구를 시행하였다. 연구 방법: 2000년 1월부터 2007년 12월까지 한림대학교 의료원의 자궁외임신 환자의 의무기록지를 조사하였다. 결과: 자궁외임신의 빈도는 13.6개의 분만당 1건이었고 호발 연령은 26~30세였다(29.5%). 위험인자는 과거 복부나 골반수술 병력(37.0%), 인공유산 병력(30.8%) 골반염 병력(12%), 난관불임술 병력(9.6%) 순이었다. 증상은 무월경(88.7%), 하복통(81.2%), 질출혈(60%) 순으로 나타났으며, 증상 발현은 마지막 생리시작일 후 6~8주가 47%로 가장 높은 빈도를 보였다. 혈색소는 10 gm/dL 이상이 79%였고 8 gm/dL 이하가 3.9%였다. 발생부위는 난관에 89%, 자궁각에 7.2%, 난소에 1.1%, 자궁경부에 2.7%였다. 수술은 복강경이 755예(71.6%), 개복술이 273예(25.9%), 소파수술이 26예(2.5%)에서 행해졌다. 수술 시 난관 절제가 82.4%로 가장 많았고, Methotrexate(MTX) 치료는 13예 (1.21%)에서 성공적으로 행해졌다. 결론: 자궁외임신의 조기진단은 혈청 β-hCG와 질초음파를 함께 이용하는 것이 가장 유용하다고 생각되며 치료는 복강경수술이 개복술에 비해 입원기간 및 합병증을 낮출 수 있어 향후 치료에 더욱 중요한 역할을 하리라 생각된다. Objective: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. Methods: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. Results: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). Conclusion: The early diagnosis of ectopic pregnancy is most useful when serum β-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.
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신생아에서 좌측 서혜부 탈장으로 오인된 정상 자궁부속기염전
손혜연 ( Hyae Yeon Son ),지은정 ( Eun Jung Ji ),문철용 ( Cheol Yong Moon ),나연식 ( Yon Sik Na ),장재혁 ( Jae Hyuk Chang ),정지윤 ( Ji Youn Jung ),문종수 ( Joong Soo Moon ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.10
A palpable mass in lower abdomen of a neonate or an infant can be most frequently considered as an inguinal hernia, whereas pediatric adnexal torsion is less commonly considered in differential diagnosis but can occur. Pediatric adnexal torsion may be difficult to diagnose clinically but the immediate diagnosis may lead to more frequent salvage of affected adnexa. Sonography is the preferred imaging study. It usually confirms a pelvic mass but may not establish the diagnosis. The correct diagnosis of adnexal torsion is often made at exploration. Therapy for adnexal torsion remains controversial. While extirpation has been the standard of treatment in the past, there are current proponents of conservative therapy with adnexal preservation.
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