골반경을 이용한 자궁외 임신의 치료 = Management of Extrauterine Pregnancy using Pelviscopy

국문 초록 (Abstract)

동국대학교 의료원 산부인과에서는 1991년 10월 1일부터 1994년 12월 31일까지 약 39개월동안 자궁외 임신으로 진단된 79명의 환자에게 골반경 수술을 시행하였다. 골반경수술은 수술후 입원기간의 단축, 개복으로 인한 불필요한 출혈의 방지 및 수술시간의 단축, 수술후 유착감소 및 반복수술의 용이성, 미용상의 효과가 좋았다. 특히 비파열성 자궁외 임신에서 골반경을 이용한 난관개구술과 MTX 국소투여법 같은 보존적 치료는 매우 효과적이었다. 그리고 난관파열이 되어 어느정도 복강내출혈이 있는 파열성 자궁외 임신에서도 골반경수술의 장점을 살리면서 시술을 할 수 있을 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Prevalence of extrauterine pregnancy has increased. With the availability of the rapid quantitative B human chorionic gonadotropin titers and more accurate sonograms, the diagnosis of probable extrauterine pregnancy is being made earlier and often before tubal rupture. Salpingectomy at the time of laparotomy has been the standard treatment for tubal pregnancy, even when the tube was not ruptured. Recently conservative surgery via salpingotomy/salpingostomy or fimbrial expression has been advocated. The pelviscopy is an essential tool in making the diagnosis and, given certain criteria, can be useful for management as well. Pelviscopic management of extrauterine pregnancy has been described extensively in last several years. These methods have been associated with low morbidity, early recovery, and short hospital stay. Although the role of medical therapy for extrauterine pregnancy is still uncertain, medical therapy of early, unruptured extrauterine pregnancy can be safe and cost effective and even result in improved fertility, compared with the standard surgical therapy. Conservative treatment of unruptured type tubal pregnancy, which have been diagnosed early, salpingotomy and salpingostomy and MTX local injection are highly effective. We have experienced 80 cases of pelviscopic surgery in 79 patients with extrauterine pregnancy. Among the procedures, salpingectomy was peformed most frequently(78.5%). Salpingotomy was also performed(12.5%), salpingectomy was performed(1.3%), pelviscopy guided MTX local injection was performed(1.3%), and fimbrial expression was performed(1.3%). Of 79 patients, complication occurred in 7 patients. In one patient with liner salpingotomy, additional pelviscopic salpingectomy was needed for bleeding control from previous salpingotomy sites. Hospital stay was averaged 3.8 days. Pelviscopic treatment of extrauterine pregnancy was simple and effective with fast recovery even in patients with pelvic adhesions due to prior operations, ruptured extrauterine pregnancies with moderate intraperitoneal free blood.