자궁탈의 임상적 고찰 = A Clinical Observation of Uterine Prolapse

다국어 초록 (Multilingual Abstract)

Two hundred and thirty seven cases of uterine prolapse of Korean women (161 cases -operated. 76 cases- not operated) were studied clinically and statistically and the results were as follows. 1) The incidence of the uterine prolapse of the Korean women found in the Obst. and Gynec. Department of the National Medical Center during the past 5 years (1959-1963) was 2.3%. 2) 105 out of 221 cases, the uterine prolapse developed before the age of 25 years, and the greater majority of the cases: 195 cases, developed before the age of 40 years. 3) The relation between the parity and the developement of uterine prolapse was as follows. Nulliparous 6 cases (2.9%), primiparous 71 cases (29.9%), 2 parous 41 cases (17.2%), 3 parous 28 cases (17.2%), 4 parous 22 (9.2%), and 5 or more parous 58 cases (29.0%). 4) The rate of spontaneous abortion of the patients with uterine prolapse was 17.2% and the secondary sterility was 16.2%. 5) According to the Gibson`s classification of prolapsus uteri, the 4 th degree (complete prolapse) was 24.5% and the 3rd degree was 42.2%. Comparing with the foreign author`s reports, a significantly high incidence of advanced degree of prolapse seemed to be partly due to the delayed admittance because of poor economic condition. 6) 22 out of 38 cases examined by the intravenous pyelography, showed some abnormalities of the urinary system such as hydronephrosis and/or hydroureter, and these were found mostly in the advanced cases with 3rd or 4th degree of uterine prolapse. 7) 9 out of 87 cases examined with N.P.N. and 6 out of 35 cases examined with serum creatinine showed abnormal values, and these abnormalities were found mostly in those cases who had suffered from the uterine prolapse for more than 10 years. 8) 147 out of 161 operated cases were followed up more than 6 months after the operations and the cure rate was as follows. Manchester operation 93.8%, vaginal hysterectomy 87.0% inter-position operation 90.6%, Le Fort 100%, making a whole figure of cure rate 91.2%. 9) As to the failure of operations, we could observe one recurrent prolapse of uterus after Manchester operations and 2 after Interposition operation, and 10 cases of recurrent cystocele, rectpcele or enterocele or combination of these. To avoid this complication it is recommended to tie and to approximate all the parametrial stumps as high up and as solidly as possible. 10) There were 2 cases of postoperative death: one died of incompatible blood transfusion, and the other died or acute pyelonephritis-uremia, which were confirmed by autopsies. 11) A high incidence of postoperative urinary infection (28.0%), wound infection and/or necrosis (15.5%), were found but these complications were well controlled with sulfadrugs and antibiotics. Since infectious complications are so common after prolapse operations prophylactic treatment with chemotherapeutica is recommended. 12) The secondary hemorrages were observed in 8 cases and 2 of them were so massive and difficult to control vaginally that the abdominal hysterectomies were carried out.