자궁근종에 대한 임상 및 병리학적 연구 = A Clinicopathologic Study on Myoma of the Uterus

국문 초록 (Abstract)

1990년 1월 1일부터 1993년 12월 31일까지 4년간 광주기독병원 산부인과에 입원하여 수술을 받고 자궁근종으로 확진된 544례를 대상으로 임상 및 병리학적 연구로 다음과 같은 결과를 얻었다.
1. 자궁근종의 발생빈도는 18.3%이었다.
2. 연령분포는 40-49세가 57.7%로 가장 많았고, 평균연령은 43.4세이었다.
3. 주소가 동통인 경우가 73.3%, 이상자궁출혈의 경우가 66.5^, 종류감이 23.9%의 순이었다.
4. 평균 혈색소치는 11.3%이었으며, 혈색소치가 10 g%미만인 경우가 10%이었다. 이중 수혈을 받은 경우는 7.7%이었다.
5. 발생부위는 체부가 96.1%, 경부가 1.8%, 광인대내가 1.7%, 체경부가 0.4%의 순이었다. 조직학적으로는 근내형이 67.8%, 혼재형이 16.2%, 장막하형 8.1%, 점막하형 7.9%의 순이었다.
6. 임신경험이 한 번도 없었던 경우가 3.5%였으며, 평균 임신횟수는 5.6회, 평균 분마뇟수는 3.1회이었다. 불임인 경우는 6.6%에서 보였으며, 이중 원발성은 3.5%, 속발성은 3.1%이었다.
7. 절제된 자궁 또는 자궁근종의 무게는 200-299 g인 경우가 26.3%로 가장 많았고, 평균무게는 197.8g이었다.
8. 자궁근종의 이차변성은 5.3%에서 보였으며, 초자양 변성이 3.9%로 가장 많았다.
9. 자궁근종과 합병된 병변은 86.6%이었고, 이중만성 자궁경부염이 49.8%로 가장 많았다.
10. 월경과다증은 56.6%에서 나타났으며, 월경과 다중과 자궁근종의 조직학적 발생부위(p$lt;0.005), 자궁선근증(p$lt;0.005) 사이에는 유의한 상관관계가 있었다. 그러나 자궁무게와 월경과다증 사이에는 유의한 상관관계가 없었다(p$gt;0.5).
11. 월경곤란증은 46.1%에서 나타났으며, 월경곤란증과 자궁근종의 조직학적 발생부위(p$lt;0.005), 자궁무게(p$lt;0.005), 자궁선근증(p$lt;0.005) 사이에는 유의한 상관관계가 있었다.
12. 수술방법은 57.7%가 복식전자궁절제술만, 42.1%에서 복식전자궁절제술 및 자궁부속기절제술을 시행하였으며, 질식자궁적출술과 자궁근핵적출술이 각각 1례씩 있었다.
13. 수술후 합병증은 31.1%에서 나타났으며, 상기도 감염이 18.4%로 가장 많았다. 수술에 따른 심각한 합병증이나 사망한 경우는 1례도 없었다.
14. 평균 입원기간은 9일이며, 10일이내의 경우가 86.4%로 대부분을 차지하였다.

다국어 초록 (Multilingual Abstract)

There were 2,975 cases of major gynecologic at Department of Obstetrics and Gynecology, Kwangju Christian Hospital from January 1990 to December 1993.
Among these, 544 cases were uterine myoma, all of which were confirmed histopathologically. A clinicopathologic study on these 544 cases was carried out to understand the clinical characteristics of uterine myoma.
The follwing results have been obtained.
1. The incidence of myoma among 2,975 cases of major gynecologic surgery during this period was 18.3%.
2. Myoma was observed most frequently in the age group 40 to 49 years, and the mean age was 43.4 years.
3. The most frequent chief complaint was pain which was observed in 426 cases (73.3%), the next abnormal bleeding in 362 cases (66.5%), palpable mass in 130 cases (23.9%) respectively.
4. The mean value of hemoglobin was 11.3% and the anemia (Hb$lt;10.5g%) was observed in 109 cases (20.0%). Transfusion was taken in 42 cases (7.7%).
5. The corporeal myoma was observed in 523 cases (96.1%), cervical in 10 cases (1.8%), combined in 2 cases (0.4%), and intraligamentary in 9 cases (1.7%) respectively. The intramural type was observed in 369 cases (67.8%), subserous in 44 cases (8.1%), submucous in 43 cases (7.9%), and mixed type in 88 cases (16.2%) respectively.
6. The parity was 3.1 in average. The infertility was observed in 36 cases (6.6%), in which the primary infertility was 3.5% and wecondary 3.1% respectively.
7. The mean weight of the resected uterine myoma was 197.8% g. In 51 cases (9.4%), the weight was below 100 g.
8. The secondary change in myoma was found in 29 cases (5.5%) and the most common change was hyaline degeneration (3.9%).
9. The most common associated condition was chronic cervictis seen in 271 cases (49.8%).
10. Hypermenorrhea was observed in 308 cases (56.6%) and there was significant correlation between the presence of hypermenorrhea and the type of myoma (p$lt;0.005), adenomyosis (p$lt;0.005) but no correlatio with the weight of myoma(p$gt;0.5).
11. Dysmenorrhea was observed in 251 cases (46.1%) and there was significant correlation between the presence of dysmenorrhea and the type of myoma (p$lt;0.005), the weight (p$lt;0.005), and adenomyosis(p$lt;0.005).
12. Total abdominal hysterectomy was performed in 313 cases (57.5%), total abdominal hysterectomy with unilateral adnexectomy in 189 cases (34.7%), total abdominal hysterectomy with both adnexectomy in 40 cases (7.4%), vaginal hysterectomy in 1 case(0.2%), and myomectomy in 1 case (0.2%) respectively.
13. The postoperative complications were found in 248 cases (45.6%) and the most common complication of these was the respiratory infection seen in 100 cases (18.4%).
14. The mean period of hospitalization was 9 days. It was below 10 in 470 cases (86.4%).