난관 폐쇄에 기인한 불임 환자에서 난관 개통술의 효용성

박찬우,차선화,양광문,한애라,유지희,송인옥,김혜옥,강인수,궁미경,이경상,Park, Chan-Woo,Cha, Sun-Hwa,Yang, Kwang-Moon,Han, Ae-Ra,Yoo, Ji-Hee,Song, In-Ok,Kim, Hye-OK,Kang, Inn-Soo,Koong, Mi-Kyoung,Lee, Kyung-Sang 대한생식의학회 2010 Clinical and Experimental Reproductive Medicine Vol.37 No.4

목적: 불임을 주소로 내원한 환자들을 대상으로 자궁 난관 조영술을 이용한 난관 불임 선별검사에서 난관 막힘의 소견을 보인 경우 선택적 난관 조영술을 시행 후 실패 시 난관 개통술을 시행하여 난관 불임치료에 있어 난관 개통술의 효용성을 알아보고 난관 막힘 부위 및 형태에 따른 난관 개통률을 비교하고자 하였다. 연구방법: 난관 불임 선별검사로서 자궁 난관 조영술을 시행하였으며 자궁 난관 조영술 상 난관 막힘 소견을 보인 215명의 342개의 난관을 대상으로 후향적 연구를 진행하였다. 결과: 난관 개통술을 시행하여 342개의 난관 가운데 248개의 난관이 개통되어 72.5%의 난관 개통률을 보였다. 막힘 부위에 따른 난관 개통률은 근위부 83.8% (197/235예), 협부 45.6% (47/103예), 원위부 100% (4/4예)를 보여 자궁-난관 접합부에 가까운 막힘 일수록 높은 개통률을 보였다. 막힘 형태에 따른 개통률은 점진형은 92.3% (157/170예), 오목형은 80.2% (69/86예), 볼록형은 25.5% (22/86예)의 난관 개통률을 보였다. 난관 막힘 부위와 형태를 종합하여 볼때 난관 근위부 점진형 막힘의 경우 91.6% (143/156예)의 높은 개통률을 보인 반면 난관 협부 볼록형 막힘의 경우에는 개통률이 11.3% (6/53예)에 불과하였다. 난관 개통에 성공한 156명 가운데 98명에서 임신에 성공하여 62.7%의 임신율을 보였다. 결론: 난관 개통술은 자궁 경부를 통한 시술로 수술적 방법이나 체외수정시술의 난자 채취에 비해 덜 침습적인 방법으로 입원치료가 필요하지 않으며 비교적 적은 비용으로 불임의 원인을 극복할 수 있는 장점이 있어 난관 원인에 의한 불임 환자에서 우선적으로 시행해 볼 수 있는 효과적인 치료 방법이라 할 수 있다. Objective: To evaluate the significance and efficacy of trans-cervical fallopian tube catheterization (TFTC) in diagnosis and optimal treatment modality for tubal blockage. Methods: The retrospective study was performed in those underwent TFTC from January 2005 to December 2009. A total of 342 fallopian tubes in 215 patients which showed tubal blockage in hysterosalpingography (HSG), were subjected to TFTC. Recanalization rate (RR) was compared according to portion of tubal blockage; proximal, isthmic and distal portion and blockage type; tapering, concave, and convex type. Results: In total, RR was 72.5% (248/342 tube). According to the portion of tubal blockage, RR was 83.8% in proximal, 45.6% in isthmic and 100% in distal portion. RR was 92.3% in tapering, 80.2% in concave and 25.5% in convex type, respectively. There were 98 pregnancies in 156 patients after successful recanalization, which shows 62.7% pregnancy rate. Conclusio: TFTC were capable of recanalizing tubal blockage in 248 of 342 tubes in 156 of 215 patients (72.5%). The RR was increased with proximal portion and tapering type tubal blockage.

불임 또는 습관성 유산 환자에서 중격자궁의 치료가 임신에 미치는 영향

구화선,차선화,양광문,배주연,안현숙,한애라,박찬우,강인수,궁미경,이경상,Koo, Hwa-Seon,Cha, Sun-Hwa,Yang, Kwang-Moon,Bae, Ju-Youn,Ahn, Hyun-Suk,Han, Ae-Ra,Park, Chan-Woo,Kang, Inn-Soo,Koong, Mi-Kyoung,Lee, Kyung-Sang 대한생식의학회 2010 Clinical and Experimental Reproductive Medicine Vol.37 No.4

목적: 중격자궁은 흔하게 보고되는 선천성 자궁기형 중 하나이며 여성의 생식능력에 미치는 영향에 대해 아직 이견이 많고, 따라서 치료의 필요성에 대해서도 아직 정립되지 않았다. 본 연구에서는 중격자궁의 존재 및 치료 여부가 생식수행에 미치는 영향에 대해 알아보고자 하였다. 연구방법: 2008년 1월부터 2009년 12월까지 불임 또는 습관성 유산을 주소로 제일병원 산부인과를 방문하여 자궁난관 조영술을 시행한 총 2,838명의 환자들 중 중격자궁이 진단된 44명의 환자들을 대상으로 하였으며, 이 중 27명은 자궁경 하 자궁중격 절제술을 시행 받았으며, 17명은 진단 후 추가적인 치료를 받지 않았다. 대조군은 동일 기간 내에 자궁기형이 진단되지 않은 환자 42명을 나이를 고려 후 무작위 선정하였다. 연구 대상군의 임신율, 자연유산율, 그리고 생존분만율 등에 대한 의무기록을 후향적으로 분석하였으며, 대상군들의 평균 추적 관찰 기간은 진단 후 21.8개월 이었다. 결과: 추적 관찰 기간 중 자궁경 하 질식 자궁중격 절제술을 시행 받은 환자 (n=27)의 55.6% (15/27)가 임신에 성공한 반면 치료를 받지 않은 환자 (n=17)의 약 23.5% (4/17)만이 임신에 성공하여 치료받은 군에서 통계적으로 의미있는 높은 수치를 보였다 (p<0.05). 한편 생존분만율은 치료를 받은 환자군 및 자궁기형이 진단되지 않은 불임 또는 습관성 유산 환자 (대조군, n=42)에서 각각 75%와 84.6%를 보인 반면 치료 받지 않은 군에서는 50% (2/4)를 보여 치료 받지 않은 중격자궁 환자에서 낮은 경향을 보이지만 통계학적 의미는 없었다. 결론: 중격자궁이 생식수행에 미치는 영향은 자연유산 등 산과적 합병증 뿐 아니라 오히려 임신력의 저하에 더 큰 악영항을 미칠 수 있으며 불임 환자에서 중격자궁의 존재 시 적극적인 치료가 임신성공률의 향상에 도움이 될 것으로 생각 되지만 보다 명확한 결론을 위해 규모가 크고 관찰 기간이 긴 대단위 연구가 필요 할 것으로 생각된다. Objective: The aim of this study was to evaluate the influences of uterine septum and their elimination on the reproductive outcomes in women who have history of recurrent spontaneous abortion (RSA) and/or infertility. Methods: The medical records of reproductive outcomes in patients who have had history of RSA and infertility who were diagnosed with uterine septum only by hysterosalpingogram (HSG) between January 2008 and December 2009 were retrospectively analyzed. The subjects who have had severe male factor, tubal factors, other uterine factors, endocrine abnormalities, peritoneal factors, and abnormal karyotyping among both partners were excluded. In 27 patients, confirmation of diagnosis by laparoscopy and elimination of uterine septum by trans-vaginal hysteroscopy was done. Seventeen patients were strongly suspected to uterine septum on HSG but tried to get pregnancy without any other procedure for evaluation and management of uterine anomaly. Age matched 42 patients who have history of RSA and/or infertility and diagnosed to normal HSG finding at same period were randomly selected as control. The medical records of reproductive outcomes were analyzed and compared between groups. Results: The mean time of observation after diagnosis was 21.8 months (10 to 32). 55.6% (15/27) of patients in patients who received trans-vaginal hysteroscopic uterine septotomy were success to get pregnancies and was significantly higher than that of 17 patients who did not receive proper management (23.5%, 4/17, p<0.05). In control population, 40.5% (17/42) were success to pregnancies and the differences were not statistically significant compared to both two study groups. The live birth rate which was excluded pregnancy loss by abnormal fetal karyotyping and congenital anomaly were 75% (9/12) in treated septated uterus group and 84.6% (11/13) in control group each which have no statistically significant different. In patients with septated uterus who did not receive proper management showed lower delivery rate (50%, 2/4) than that of other groups but was not statistically significant. Conclusion: According to present data, women with a uterine septum have an increased chance of successful pregnancy with improved obstetric outcome after proper management of the uterine cavity. And these results were showed in patients with no regard to their reproductive history. But, in case of failed to receive proper management, uterine septum can affect not only pregnancy ongoing but successful pregnancy too.

부인과영역의 종양 및 종류와 난관자궁조영술

이승호(SH Lee),이태호(TH Lee) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.4

Hysterosalpingographic studies were carried out on the 29 cases of female genital neoplasms with 16 cases of leiomyoma and 13 cases of ovarian tumors, including a case of corpus luteum cyst, through March 1 1980 to Dec 31 1980 at our Ob. and Gyn. Department. The result summarized were as follows On the hysterogyaphic studies of the uterine leiomyoma cases with irregular and regular edge of cavum uteri were 7 cases or 43.8% and 9 cases or 56.2% respectively. Cases which revealed filling defect were 10 cases or 62.5% and among these, 8 cases were local in origin, showed most part. The pictures of filling defects were variable, polyp like, spherical, semispherical, irregulary lobulate, semilunar and sickel form etc. cases revealed enlarged uterine cavum were 6 cases or 37.5% and cases with deformed 7 cases or 43.8%. Tubal elongation on the affected side was observed 11 cases out of 13 cases revealed 84.6% and tumor surface coating was seen only 4 cases or 36.4%. Calcification was recongnized on 2 cases of mucinous cystadenoca.

정상 자궁난관조영을 보이는 불임 환자에 있어서 복강경술의 의의

권종희 ( Jong Hee Kwon ),서성석 ( Seong Seog Seo ),김미란 ( Mi Ran Kim ),황경주 ( Kyung Joo Hwang ),장혜진 ( Hye Jin Chang ),장석준 ( Suk Joon Chang ),유희석 ( Hee Sug Ryu ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.2

Objective: To evaluate the value of laparoscopy in infertile women with normal hysterosalpingograms. Methods: Retrospectively analyzed the laparoscopic findings of 79 infertility patients with normal hysterosalpingograms. Results: Of the 79 patients, 28 (

불임환자에서 sonohysterography의 이용

이춘희 ( Chun Hee Lee ),김광수 ( Gwang Soo Kim ),이동영 ( Dong Young Lee ),박철민 ( Chul Min Park ),오영은 ( Young Eun Oh ),이택후 ( Taek Hoo Lee ),전상식 ( Sang Sik Chun ) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Objective: The purpose of this study was to assess the usefulness of sonohysterography in the detection of abnormalities of the uterine cavity in infertile patients, compared with other diagnostic methods, such as transvaginal sonography, hysterosalpingography and hysteroscopy. Methods: Three intrauterine pathologies including intrauterine synechiae, endometrial polyp and submucosal myoma, that could be possible causes of infertility were diagnosed. Results: Transvaginal ultrasonography and hysterosalpingography were able to detect 41.7% and 83.3% of uterine pathologies respectively comparing with sonohysterography to detect all of the uterine pathologies. Conclusion: Our results show that sonohysterography is easy, inexpensive, well-tolerated and non-invasive technique with high sensitivity in the detection of uterine pathologies. Therefore the use of sonohysterography for the diagnosis of intrauterine pathologies in infertile patients is highly recommended.