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이선경,김승보,이재현,이보연,곽희중,변종원 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.9
This study was undertaken for the clinical analysis and evaluation on 171 patients with incompetent internal os of the cervix, who were admitted and treated with McDonald operation or Shirodkar operation at the KyungHee Medical Center from January 1985 to December 1994. The results of this study were as follows: 1. The incidence of this IIOC was 0.89% of 19,279 cases of total delivery. 2. The mean age of IIOC was 29.8 years old. 3. The average number of gravida was 3.9. 4. The most common contributary factor was previous history of artificial abortion(50%), and midtrimester abortion(16%), cervical laceration due to previous vaginal delivery(8%), cervical dilatation(6%) etc. was followed. 5. The success rate of operation was 77%, and the highest success rate(82%) was revealed with period from 15th weeks to 16th weeks of gestation. 6. When cervical dilatation was abscent or small, the success rate of operation was high. 7. The factors of failed operation was PROM(51%), preterm labor(36%), and infection, bleeding, FDIU. 8. The delivery method after operation was vaginal delivery in 93 cases (71%) and cesarean section in 39 cases(29%).
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이선경,김승보,이재현,곽희중,추민호 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2
저자들은 10년간 (1984~1993) 본원에서 시행되었던 64예의 제왕절개 자궁적출술에 대하여 임상적으로 고찰한 결과 다음과 같은 결론을 얻었다. 1. 제왕절개 자궁적출술은 질식분만후 (0.087%)보다 제왕절개 후 (1.08%)빈도가 더 높았다.(p$lt;0.0001). 2. 연령에 따른 제왕절개 자궁적출술의 빈도는 25세에서 29세 산모군에서 가장 높았다. 3. 경산횟수에 따른 제왕절개 자궁적출술의 빈도는 초산부(0.46%)보다 경산부(3.30%)에서 더 높았다. 4. 제왕절개술후 제왕절개 자궁적출술을 시행했던 53예에서 제왕절개술의 적응증은 자궁무력증이 43.4%로 가장 많았으며, 그 다음으로 유착태반이 동반된 전치태반, 임신을 동반한 자궁근종, 유착태반, 자궁파열 순이었다. 5. 제왕절개 자궁적출술의 적응증은 자궁무력증이 50%로서 가장 많았으며, 그 다음으로 태반이상, 임신을 통반한 자궁근종, 자궁파열의 순이었다. 6. 제왕절개 자궁적출술의 적응증에 따른 수혈량은 자궁무력증의 경우 평균 12.44 pints, 자궁파열의 경우 평균 9 pints, 태반이상의 경우 평균 8.5 pints 순으로 수혈을 요하였다. 7. 제왕절개 자궁적출술시의 신생아는 만삭아가 64예중 39예로 가장 많았다. 8. 제왕절개 자궁적출술의 합병증으로 방광 손상이 2예, 범발성 혈관내 응고장애가 7예, 창상파열이 4예, 혈종이 5예 그리고 파종성 혈관내 응고증으로 인해 사망은 2예 있었다. This report was undertaken to determine the present status of cesarean hysterectomy . cesarean hysterectomy was originally derived to prevent postcesarean infection and hemorrhage and reduce the maternal morbidity and mortality after the operation and its indications have gradully been widened to include many conditions in which removal of uterus is necessary or desirable. In this study, the outcomes of 64cases of cesarean hysterectomy performed at Kyung Hee University Hospital for 10 years from January, 1984 to December, 1993 were reviewed. There were 17,605 deliveries during this period, cesarean hysterectomy was prefomred in 53 of 4,930 cesarean sections (1.07%) and in 11 of 12,675 vaginal deliveries(0.087%) so more frequency after cesarean section than vaginal delivery. the age of patients varied from 21 to 42 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indications of cesarean hysterectomy was uterine atony (50%), followed by placental disoredrs (34.38%) uterine myoma with pregnancy (14.06%) and uterine rupture (1.56%). All patients who had cesarean hysterectomy received transfusion from 1 pint to 52 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coagulopathy and wound disseminated intravascular coagulopathy. Postoperative complication still remains the main cause of materanal mortality, therefore, carefull prenantal care, momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjuction with maternal lifesaving.
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