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근막 결손의 복원과 자궁천골인대 고정을 통한 전자궁적출술 후 질탈출의 성공적 교정
문화숙(Hwa Sook Moon),최진국(Jin Koo Choi),김경서(Kyung Seo Kim),박근식(Kyun Sik Park),황지영(Ji Young Hwang),문성은(Sung Eun Moon),한지원(Ji Won Han),김상국(Sang Gook Kim),김상갑(Sang Gap Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7
목적 : 본 연구는 전자궁적출술 후 질탈출을 부위-특이적인 결함의 개념에 입각하여 치골경부 근막과 직장질 격막의 연결을 통한 골반내 근막의 복원과 자궁천골인대 고정술을 이용한 질탈출의 성공적인 수술적 교정의 방법과 결과를 보고하고자 한다. 연구 방법 : 1999년부터 2001년 8월까지 자궁적출술 후 질궁탈출 증상으로 문화병원 산부인과를 내원, 탈출된 질의 근막을 재건시킨 다음, 이를 자궁천골인대에 고정시킴으로써 질의 부위-특이적인 교정술을 받은 3명의 환자를 대상으로 하였다. 3명중 1명은 개복술을 하였고 2명은 내시경 수술을 하였다. 결과 : 환자의 연령 분포는 49-67세였으며, 수술시간은 평균 113분 (105-125)이었다. 세 환자 모두 수술 후 질의 상태가 해부학 및 기능적으로 정상이었으며, 9일째 특이사항 없이 퇴원하였다. 수술 후 HRT를 시행한 1명을 포함한 3명 모두 각각 24개월, 12개월, 7개월간의 추적 검사에서도 특이한 합병증이나 재발 없이 좋은 경과를 보였다. 결론 : 골반 근막 결손의 복원과 자궁천골인대 고정술은 전자궁적출술 후 질탈출의 교정에 매우 안전하고 효과적이며, 기능적인 방법으로 사료되며, 자궁천골인대를 질탈출 교정에 이용한 연구는 본 연구가 국내에서 처음이다. Objective : To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. Methods : This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. Results : The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. Conclusion : The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.
Nitric Oxide가 인간 정자세포의 기능에 미치는 효과에 대한 연구
주보선,문화숙,박수진,문재연,조재동,김한도,Joo, Bo-Sun,Moon, Hwa-Sook,Park, Sue-Jin,Moon, Jae-Yeoun,Cho, Jae-Dong,Kim, Han-Do 대한생식의학회 1998 Clinical and Experimental Reproductive Medicine Vol.25 No.1
This study was performed to determine the effects of nitric oxide on human sperm cell function. Semen samples were obtained from normal healthy volunteers. Motile spermatozoas collected by swim-up method were incubated up to 24 hours in Ham's F-10 medium supplemented with a various concentration of sodium nitroprusside (nitric oxide releasing agent). Sperm motility, hyperactivation, acrosome reaction rate, and acrosin activity were determined. The results are as follows; 1. 1mM of SNP resulted in a significant decrease in sperm motility ($44.8%{\pm}8.9%:78.1%{\pm}6.3%$, and hyperactivation $(10.4%{\pm}6.4%:47.7%:{\pm}9.5%)$ after incubation for 3 hours compared with the control group (Ham's F-10 alone), but had no effect on acrosome reaction. 2. At $100{\mu}M$ SNP, sperm motility was reduced after incubation for 6 hours $(54.8%{\pm}3.2%)$ compared with that of the control group $(82.7%{\pm}8.9%)$, but hyperactivation and acrosome reaction were not affected. 3. However, a lower concentration (less than $10{\mu}M$) of SNP had no effect on sperm motility and hyperactivation for 8 hours of incubation but significantly decreased them when incubation periods were increased up to 24 hours compared with the control group. On the other hand, $1{\mu}M$ and $10{\mu}M$ SNP significantly increased the acrosome reaction rate in both acrosomal status ($17.3%{\pm}5.2%$, $23.5%{\pm}4.7%$, respectively) and acrosin activity ($34.3{\mu}IU{\pm}10.5{\mu}IU,\;45.6{\mu}IU{\pm}5.6{\mu}IU$, respectively) as compared with the control group $(7.0%{\pm}4.0%,\;9.5{\mu}IU{\pm}3.4{\mu}IU)$. These results indicate that SNP, NO releasing agent, has a dose-dependent effects on the sperm cell function. Therefore it may positively affect the fertilization by promoting acrosomal reaction at a lower concentration (less than $10{\mu}M$).