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박은주(EJ Park),공훈식(HS Kong),나준희(JH Na),김종혁(JH Kim),김용만(YM Kim),김영탁(YT Kim),강병문(BM Kang),남주현(CH Nam),목정은(JE Mok) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8
Traditionally, the myomectomy has been performed via laparotomy and there have been some reports that laparoscopic myomectomy has advantages of reduced intra-and postoperative morbidity, shorter hospital stay and recovery time, earlier return to normal activities, fewer postoperative adhesions and better cosmetic scars as compared with traditional abdominal myomectomy. However, the disadvantages of the laparoscopic myomectomy include increased operating time, inability to palpate the uterus during operation, and the requirement of advanced technical skills. Actually the role of laparoscopic myomectomy remains controversial until now. We experienced 33 cases of laparoscopic myomectomy from January 1996 to December 1997, but most of them were performed ancillarily during other operations for ovarian tumors, pelvic endometriosis, tubal pregnancies, etc. Among 33 patients, ten received laparoscopic myomectomy as a major procedure. We present clinical characteristics of these patients and laparoscopic procedures we performed. The average age of patients was 36.0±7.0 (mean±S.D.) years and the mean parity was 1.3 (±1.2). The myomas were subserosal type in 5 cases, intramural type in 4 cases and intraligamentary type in one. The maximal diameter of the myomas ranged from 1.5 to 7.5 cm and the mean diameter was 5.2 (±1.6) cm. Seven cases had only one myoma, but 3 cases had two or more. The operation time ranged from 65 to 200 minutes (mean: 121.5±46.4) and average hemoglobin change(preoperative- postoperative hemoglobin) was 2.5 (±1.2) g/dl. There was no intraoperative and postoperative complication except one case of trocar site hemorrhage. In conclusion, the laparoscopic procedure is effective for myomectomy, but it is essential to adhere to the basic surgical principles to optimize its safety and efficacy. However, its advantages are still needed to be established based on long term outcomes.
융모막 융모 및 임신성 융모성 질환에서 bcl-2 단백의 발현에 관한 연구
김영탁(YT Kim),허주령(JR Huh),김종혁(JH Kim),나준희(JH Na),연규선(KS Yeon),공훈식(HS Kong),김용만(YM Kim),남주현(CH Nam),목정은(JE Mok) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9
Bcl-2 is a proto-oncogene that inhibits apoptosis induced by hormones and cytokines and thus extends cell survival, exposing the cell to oncogenic stimuli. It is expressed in various normal tissues and neoplasia, often associated with prognostic significance. In normal placenta, only syncytiotrophoblasts have been found to express bcl-2. The role of bl-2 in gestational trophoblastic disease (GTD) is largely undetermined. In this study, the authors examined the possible role of bcl-2 in oncogenesis of GTD. Bcl-2 protein in 34 cases of GTD was examined by immunohistochemical staining on routinely processed paraffin-embedded tissues, using antihuman mouse monoclonal antibody according to standard streptavidine biotin method. Cases included 21 hydatidiform moles (H-mole), 7 invasive moles, 4 choriocarcinomas and 2 placental site trophoblastic tumors (PSTT). As controls, we included 5 first trimester pregnancy, 5 abortions and 4 normal endometrium. In normal first trimester placental tissues, distinct strong diffuse cytoplasmic staining for bcl-2 was observed only in syncytiotrophoblastic cells, but not in cytotrophoblasts or intermediate trophoblasts. The reaction was stronger than in gestational endometrial glandular cells. In H-moles, diffuse cytoplasmic staining of syncytiotrophoblasts was noted in 17 cases (81.0%). The reaction was similar to, or weaker than normal in placental tissue. In invasive moles, weak to moderate staining was noted in trophoblasts invading myometrium in 3 cases (42.9%). In choriocarcinomas, weak cytoplasmic stain was seen in syncytiotrophoblasts in 1 cases (25.0%). Two case of PSTT showed diffuse cytoplasmic staining in some syncytiotrophoblasts and intermediate trophoblasts. There is a significant inverse relationship between the expression of bcl-2 and the aggressiveness of GTD. This study shows that the exclusive localization of bcl-2 in syncytiotrophoblasts is well maintained in hydatidiform moles and invasive moles, whereas almost absent staining is seen in choriocarcinoma and PSTT. Inverse relationship between bcl-2 expression and aggressiveness of GTD suggests that other molecular events are required for tumorigenesis of GTD, by which expression of bcl-2 can be altered or bcl-2 function as a tumor suppressor gene depending on cell type.