Mehotrexate 국소요법으로 치유한 자궁경관임신

김난경(NK Kim),정영주(YJ Jung),류철희(CH Rhyu),오병찬(BC Oh) 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.4

저자들은 자궁경관임신으로 진단받고 태아 심박동이 확인된 환자에서 MTX 전신요법을 사용 하여 실패한 후 질초음파하에서 양막강내 MTX 직접 주십을 시도하여 성공하였다. 임신능력을 유지하기 위해 자궁보존을 목적으로 하는 경우, 초기에 진단되는 자궁경관 임신 에서 치료방법으로 양막내 MTX 직접 투여를 시도해 볼가치가 있다고 사료되는 바이다. The possibility of fertility loss is nerver greater than with a cervical pregnancy, the rarest type of ectopic gestation. Methotrexate has been utilized recently for the successful management of tubal, interstitial and cervical ectopic gestations. We report a case in which a viable cervical pregnancy was diagnosed in the first trimester and in which the patient was successfully treated with intraamniotic methotrexate administraion guided by transvaginal ultrasonography without surgery after failure fo systemic methotrexate management.

불임환자에서 자궁근종절제술 후 임신성공률

김종덕,류철희,김관식,김난경,조한구,김태실 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.10

Uterine myoma is the one of the most common tumor of female genital tract. It causes infertility and many other complications associated with pregnancy. This study was undertaken to evaluate the efficacy of transabdominal myomectomy on 48 patients who suffered from infertility and hibitual abortion at the Department of Obstetricas and Gynecology in Chonbuk National Uniersity Hospital from 1985 to 1994. The results are as follos: 1. Average age of patients was 32.2. The number of nulligravida patients was 17 and infertility duration raged from 12 months to 156 months. 2. Twenty two out of 48 women(45.8%) were conceived. 3. Pregnancy rate after myomectomy showed some difference dependign on surgical indication. In case, the uterine myoma was the only surgical indication, the pregnancy rate was 68.8%, while the rate was 26.7% when other factors of infertility were combined with uterine myoma. 4. The average time period from operation to conception was 13.8 months. Fifteen of the 22(68.2%) conceived in the first year after operation and 19(80.4%) conceived within two years. 5. Pregnancy rate also depended on the age of patients. Forteen out of 21 patients of under 30th conceived, while only 18 out of 72 patients above 30th conceived and there was no pregnancy over 36 years of age. 6. Finally pregnancy rate according to the size and number of myoma was studies. Fifty percent of solitary myoma patients conceived, while only 35.7% of multiple myoma patients conceived. Pregnancy rate of the patient of solitary myoma with diffrent size was similar, indicating moma size was not an influencing factor to the pregnancy rate. In conclusion myomectomy can be strongly recommended with good success expectation for the infertile women if uterine myoma be considered as the main cause of infertility while other causes are not clear, particularly below 35 years of age.

반복자연유산의 세포유적학적 연구

김종덕,진소자,서승식,김관식,김난경 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.12

저자는 전라북도 지역에서 자연유산아의 염색체 이상의 빈도 및 종류를 알아봄으로써 반복적인 자연유산을 호 소하는 환자들의 상담 및 치료에 유용한 정보를 얻기 위하여 1988년 5월부터 1994년 6월까지 전북대학교병원 산부인과에 자연유산을 주소로 내원한 환자와 남편의 정맥혈을 이용하여 세포 유전학적 검사를 시행하여 다음 과 같은 결과를 얻었다. 1. 염색체 이상의 빈도는 43.7%였고 상염색체 삼체성이 46.7%를 가장 많았으며, monosomy X 가 24.5% 구조적 이상이 15.6%의 빈도를 보였다. 2. 상염색체 삼체성중 16번이 38.1%로 가장 높은 빈도를 보였고, 21번이 23.7%, 18번이 19.0%의 순위였다. 3. 나이에 따른 염색체 이상의 빈도는 큰 차이를 보이지 않았으나 autosomal trisomy 의 빈도는 모성 나이가 많아짐에 따라 다소 증가하였다. 4. 염색체의 구조적 이상을 보인 9예에서 양쪽 부모 중 하나가 염색체이상을 갖는 경우는 6예(66.7%)였다. 이상과 같은 결과로 전라북도 지역에서 자연유산아의 염색체이상의 빈도는 서구의 보고와 비슷하였으나 구조 적 이상의 빈도가 비교적 높았으며 이들은 대부분 부모에서 유래되는 유전적인 것으로 판명되어, 차기 임신의 적절한 처치를 위해서는 산전 유전상담 및 가족의 염색체 검사가 병행되어야 함을 시사해 주고 있으며 나이가 많아짐에 따라 상염색체 삼체성의 빈도가 증가되는 것으로 미루어 고령산모에서 유전상담 및 산전염색체 검사 가 필수적임을 재확인할 수 있었다. 삼체성중 특히 18번의 빈도가 서구의 보고에 비해 높았는데 이에 대한 배경을 밝히기 위해서는 자연유산아에 대한 보다 많은 국내의 연구례가 집약되어져야 할 것으로 생각된다. It has been known that chromosomal abnormalities of abortus is the most common cause of spontaneous abortion, but the frequency and the type were reported variations in different countires and races. In order to evaluated the frequency and type of chromosomal abnormalities of abortus in Chonbuk provincial area, a cytogenetic study was performed in 119 abortuses and their aborters from May. 1988 to June, 1994 in Chonbuk National Unviersity Hospitial. The frequency of abnormal karyotypes in abortuses was 43.7% ; autosomal trisomy was predominent (46.7%), followed by monosomy X(24.4%) structural aberrations (15.6%) and polyploidy (6.7%). Among trisomies, chromosomes 16(38.1%), 21(23.7%) and 18(19.0%) were prevalent. There was no statistical significance of frequency of chromosomal abnormality by maternal age, but trisomy was slightly increased in elder women. The frequency of structural aberrations was significantly higher than western countries, and almost of the abnormalities were inherited from their parents. An additional study is necessary to explain the prevalence of trisomy 18 in this area than western countries.

유전상담 및 태아염색체 분석 적응증으로써의 초음파 이상소견

진소자,김난경,유은영,나미옥,정영주 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.9

11988년 7월부터 1993년 8월까지 초음파상 이상소견을 보여 산전염색체 검사 및 유전상담을 시행한 152례중 염색체 이상을 보인 31례의 초음파 소견 및 임상기록을 검토한 바 다음과 같은 결론을 얻었다. 1. 초음파상 이상소견을 보인 152예중 염색체이상의 빈도는 20.4%(31/152례)로 대조군의 6.7%에 비해 의의있게 높았다.(p$lt;0.05). 2. 초음파상 cystic hygroma, IUGR(Intrauterine growth retardation), omphalocele, CHD(Congenital Heart disease), increased space of cisternal magna, small stomach size 및 Hydramnios는 산전 염색체 검사의 중요한 소견으로 간주되었다. 3. 염색체이상 중 48.4%(15/31례)에서 실시된 MSAFP중 autosomal trisomy와 triploidy시 0.5MoM 이하로 매우 낮았는데, 이는 산전 MSAFP screeing이 매우 의의 있는 검사임을 재확인할 수 있었다. Although it has been known that fetal chromosomal abnormality was frequently accompanied by polymalformation, amniotic fluid disorder and growth retardation, the relationship between these two has not been made clear yet. CVS or amniocentesis has been increasingly applied to the high-risk pregnant woman in genetic aspects to detect chromosomal abnormality of fetus, but it has been found that infants with congenital anomaly or chromosomal abnormality were often delivered by low-risk pregnant woman. To study the relationship between fetal chromosomal abnormality and abnormal sonographic findings will therefore contribute to not having untreatable neonate delivered and thereby keep the individual and society from the unhappiness. We report sonographic findings and clinica reports of 31 cases with aneuploidy among 152 cases which prenatal and postnatal chromosomal analysis and genetic counselling were performed after ultrasound diagnosis about abnormal findings between July 1988 and August 1993. We selected as a control that 60 amniocentesis were processed by the our department for prenatal diagnosis in mother aged 35 and over during the same period. 1. Among 152 cases with abnormal sonographic findings. The frequency of chromosonal abnormality was significantly higher than control group(20.4% in the abnormal group versus 6.7% in the control group.p$lt;0.05). 2. The sonographic findings such as cystic hygroma, IUGR, omphalocele, CHD increased space of cisterna magna, small stomach size & hydramnios were regarded as important indication of prenatal chromosomal analysis. 3. 15 cases(48.4%) out of 31 cases with chromosomal abnormality were evalusted as MSAFP. Among them, autosomal trisomy % triploidy were evaluated as having MSAFP less than a 0.5 multiple of median. Therefore it may be sure that antenatal MSAFP screening program is a very meeningful method for evaluation of congenital malformation and chrnomosomal aneuploidy in the fetus. And also abnormaal ultresonographic findings especiaaly cystic hygroms, severe IUGR and multiple abnormalities were major indications of prenatal chromosomal analysis and genetic counselling.

Ritodrine Hydrochloride (Yutopar) 와 Magesium Sulfate (Magrose) 의 조기진통 및 부작용에 대한 비교탐구

조성남,이호성,김난경,유은영,정영주,송완례 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.8

1990년 1월 1일부터 1992년 12월 31일까지 만 3년동안 전북대학교병원 산부인과에 입원 가료한 100례의 조기진통 환자중 ritodrine hydrochloride를 사용했던 44례와 magesium sulfate를 사용했던 34례를 연구군으로 절대안정요법 및 수액요법으로만 치료했던 22례를 무작위로 추출하여 대조군으로 한바 다음과 같은 결론을 얻었다. 1. 조기진통의 빈도는 총 분만수에 비해 8.6-9.5%를 나타냈다. 2. 조기진통의 모성측 위험인자로는 조기 양막파수, 자궁경관 무력증, 조산의 기왕력, 진치태반, 융모양막염, 양수과다증, 다태임신, 신우신염, 자궁근종 순이었으며 또렷한 원인인자가 없는 경우가 전체의 37%를 차지하였다. 3. 임신지연기간은 ritodrine으로 치료했던 군은 21.36+-4.62일, magrose로 치료했던 군은 20.03+-4.93일로 두군간의 유의한 차이가 없었으나 안정과수액요법만을 사용했던 대조군의 8.82+-3.62일에 비해 두군 모두에서 현저히 증가(p$lt;0.01)하였으며 분만시기도 ritodrine군은 35.61+-2.39주, magrose군에서 35.59+-2.71주로 역시 두군간에 유의한 차이가 없었으나 대조군의 34.28+-1.69주에 비해 두군 모두에서 증가(p$lt;0.05)하였다. 4. 치료성적은 ritodrine으로 치료했던 군은 완전성공율 15.9%, 불완전성공율 27.3%로 총 성공은 43.2%였으며 magrose로 치료했던 군은 완전성공율 11.7%, 불완전성공율 26.6%로 총 성공율 38.3%로 두군간에는 유사하였으나 대조군에서는 불완전 성공율 18.0%만을 나타내었다. 5. 부작용으로는 ritodrine 투여군에서 산모와 태아의 빈맥, 칼륨증, 저혈압, 흉부 불편감과 오심 및 구토, 저칼슘증, 흉부불편감과 홍조순으로 위장관 장애가 많이 나타났으며 전혀 부작용이 없는 경우는 magrose군에서 32.4%로 ritodrine군의 20.5%보다 많았다. 2차 약제 추가 투여가 필요한 경우는 ritodrine군과 magrose군이 각각 13.6%, 26.5%로 magrose군이 많았으며 그 원인으로는 자궁수축이 조절되지 않은 경우가 각각 4.5%, 20.6%, 부작용이 심한 경우가 각각 9.1%, 5.9%로 ritodrine군에서 부작용이 많은 것으로 나타났다. 6. 신생아 체중 Apgar 점수는 세군 모두에서 유사하였으나 호흡곤란증후군의 발생율은 ritodrine 군에서 9.1%로 magrose군의 14.7%와 대조군의 22.7%에 비해 감소하였으나 통계학적 의의는 없었다. Prematurity, together with its complication, remains the most frequent preventable cause of neonatal loss. In an attempt to prevent the sequalae of premature delivery attention has logically centered on effort to find safe and effective tocolytic drugs. The drugs most commonly used in this country for the suppression of preterm labor are ritodrine hydrochloride and magestium sulfate and its efficacies were assessed by several means. This study was undertaken to assess the clinical efficacies of ritodrine hydrochloride and magesium sulfate on 78 patients admitted with preterm labor from Jan. 1, 1990 to Dec. 31, 1992. The results were as follows: 1. The incidence of preterm labor was 8.6-9.5% of total number of delivery. 2. The risk factors of the preterm labor were premature rupture of membrane, incompetent cervix, previous preterm delivery, placenta previa, chorioamnionitis, hydroamnios, twin pregnancy, pyelonephritis, and uterine myoma in order, but 37% of preterm labor had no apparent risk factors. 3. The days gain in uterus was no statistically difference between the ritodrine group and the magrose group but markedly longer in the two groups than the control group (p$lt;0.01). And the delivery time was also no statistically difference between the ritodrine group and the magrose group but significantly increased in the two groups than the control group(p$gt;0.05). 4. The rate of full success and incomplete success was similar as 15.9% and 27.3%(total success rate 43.2%) in the ritodrine group, 11.7% and 26.6%(total success rate 38.3%) in the magrose group but only 18.0% incomplete success rate was showed in the control group. 5. The side effects were much more in the ritodrine group than the magrose group but patients requiring second-line therapy were mych more in the magrose group than the ritodrine group. 6. Mean body weight and apger score of neonates were simillar in the three groups but the respiratory distreas syndroms was decreased in the ritodrine group than the magrose and control groups without statistical significance.

Doo`s SACSIH 수술과 전자궁적출술후 환자와 배우자가 느끼는 심신의학적인 면에서의 비교연구

두재균,김관식,채규정,이민아,김난경,유은영,박경배,나미옥,안석문 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.2

1992년 11월 18일부터 두씨색시(Doos SACSIH)수술을 받은 31명과 같은 기간동안 전자궁적출술( TAH)를 받은 31명을 대상으로 수술후 최소 5개월이상 경과된 상태에서 그 배우자와 함께 실시한 성적 및 심신의학적면의 비교 추적조사 연구결과 다음과 같은 결론을 얻었다. 1. 수술후 환자자신이 느끼는 심적 부담요인은 두씨색시(Doos SACSIH)군에서는 체중증가가 32.3%로 가장 높았으나 전자궁적출술(TAH)군에서는 성욕감퇴가 29.1%로 가장 높았다. 2. 수술후 골반통이나 요통의 정도는 고통을 호소하지 않는군이 두씨색시(Doos SACSIH)군에서는 51.6%이었으나 전자궁적출술(TAH)군에서는 32.2%이었다. 3. 수술전과 비교하여 수술후 성적욕구의 변화정도는 성욕감퇴 현상을 보여주고 있는 군이 두씨색시(Doos SACSIH)군은 19.3%인 반면 전자궁적출술(TAH)군은 32.3%이었다. 4. 수술후 연령별 성교횟수는 연령별로 가장 많은 40대를 살펴보았을때 2주당 1회이하의 적은 성교횟수를 보여주고 있는 군이 두씨색시(Doos SACISIH)군은 33.3%이었으나 전자궁적출술(TAH)군은 78.9%이었다(p$lt;0.05). 5. 수술후 성적오르가즘의 변화정도는 수술후 나빠졌다고 호소하는 군이 두씨색시(Doos SACISIH)군에서는 12.9%이었으나 전자궁적출술(TAH)군에 있어서는 41.9%이었다(p$lt;0.05). 6. 수술후 남편이 느끼는 성생활 관계에 대한 욕구정도는 욕구가 감소되었다고 호소하는 군은 두씨색시(Doos SACISIH)군은 14.4%이었으나 전자궁적출술(TAH)군은 50.0%이었다. Since November 18 of 1992, we have undertaken a comparative study concerning the patients and their spouses at least five months after the operation. We chose 31 patients who were operated by Koos SACSIH operation and the same number of the patients who and psychsomatic aspects occured after each operation. And we cmae to the following conclusion: 1. Of the patients subjective complaints, weight gain was the highest after Koos SACSIH:32.3%; decrease in sexual desire was the highest after TAH: 29.1%. 2. 51.6% of the patient after Koos SACSIH had no complaint of pelvic pain and lumbago and 32.3% after TAH. 3. 19.3% of the patients after Koos SACSIH complain of decrease in sexual desire and 32.3% after TAH. 4. 33.3% of the patients in their forties after Koos SACSIH had coital frequency less than once in 2 weeks and 78.9% after TAH(P$lt;0.05). 5. 12.9% of the patients after Doo's SACSIH complained that their sense of sexual orgasm has become deteriorated and 41.9% after TAH(p$lt;0.05). 6. 14.4% of the patients' spouses after Doo's SACSIH complained that their sexaul desire has decreased and 50.5% after TAH.

혼전 인공유산의 경험에 관한 연구

이정우,김종덕,두재균,하정미,채규정,이용,김난경,유은영 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.9

1991년 3월부터 1991년 7월까지 5개월동안 전북대학교병원 산부인과에 내원한 환자중 최소 1회이상의 인공유산 경험이 있는 735명을 interview하여 다음과 같은 결과를 얻었다. 1. 인공유산을 경험한 여성 736명중 미혼시 인공 유산의 경험이 있는 여성은 236명으로 31.8%이 었다. 2. 고학력, 대도시, 카톨릭에서 미혼시 인공유산을 경험하는 비율이 높았다. 3. 인공유산시 태아주수는 대개 6-8주사이에서 이루어지며 시술기관은 산부인과 개인의원이 83.8% 로 가장 많았다. 4. 인공유산의 결정은 71.8%에서 배우자와 상의에 의하여 이루어지며 단독결정은 22.2%이고 부모와의 상의는 단지 2.6%에 불과하였다. 5. 인공유산 결과에 대한 심경은 만족하는 쪽이 38.5%, 그저 그렇다가 40.6%, 후회하는 쪽이 20.1%이었다. 6. 인공유산후 결혼까지의 기간은 2년이내가 68.8%이었다. 7. 미혼시 임신과 관련된 배우자와 현배우자와의 관계는 다른 배우자와의 결합한 경우 22.3%이었다. We have interviewed 736 women patients who had experienced at least one artificial abortion from March 1991 to July 1991. Among the women interviewed, 234 have appeared to have artificial abortion before marriage. Based on a thorough analysis of these women, we have done an in-depth analysis of various problems rising from artificial abortion before marriage. The results obtained were summarized as follows; 1. Among 736 women who experienced artificial abortion, 234 had their abortion before marriage. 2. Those who are Catholics of reside in the big city area, or have higher educational background have experienced more of artificial abortion before marriage. 3. Most of artificial abortions(83.8%) were performed in individual office of the physicians who are specialized in obstertrics and gynecology and its performed gestational weeks were mostly six to eight. 4. 71.8% of abortion was decided under the consultation with the partner; 22.2%by the individual; only 2.6%under the consultation with parents 5. 38.5% of women considered artificial abortion and its consequence satisfactory; 20.1% regretful: only 2.6%under the consultation with parents. 6.After the artificial abortion 68.8%of women married in next two years. 7. 22.3% of women who went through artificial abortion married other than their prior partner.