양성 골반낭종에서 경질 초음파 흡인술의 효용성
Efficacy of transvaginal ultrasound-guided aspiration in benign pelvic cyst
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목적: 본 연구는 양성 골반 낭종에서의 경초음파 흡인술의 임상적 효용성 및 안전성을 평가하기 위해 시행되었다. 연구 방법: 1996년부터 2004년까지 골반 낭종의 경초음파 흡인술을 시행 받은 343명의 환자를 대상으로 의무기록을 조사하였으며, 환자의 나이, 분만수, 잠정진단명, 초음파 상 낭종의 크기, 흡인술의 종류, 흡인액의 성상, 흡인액의 세포병리검사 결과, 단기 및 장기 추적관찰시의 초음파 상 낭종의 크기, 그리고 시술 후 합병증을 조사항목으로 하였다. 결과: 림프 낭종을 제외한 모든 종류의 양성 골반낭종에서, 경초음파 흡인술을 시행 후 단기 및 장기 추적관찰에서 유의하게 크기의 감소가 있었다 (P<0.05). 그러나 경초음파 흡인술 후 장기 추적관찰에서 단순낭종, 자궁내막종, 가성낭종 그리고 림프낭종이 완전 소실되거나 낭종의 평균 직경이 50% 이상 감소한 경우는 각각 37%, 24.8%, 28%, 그리고 30%임을 확인하였다. 흡인술과 연관된 위중한 합병증은 난관난소농양 1예와 방광천공 1예를 제외하고는 없었다. 결론: 본 연구 결과, 양성 골반 낭종의 경초음파 흡인술은 간단하며 안전한 시술이나, 치료적 효능이 제한적이므로 단순낭종, 가성낭종, 림프낭종에서의 그 적용은 신중하여야 한다. 그러나 임신을 원하는 자궁내막종 환자들에서는 난소기능을 보존할 수 있는 좋은 방법이 될 수 있다.
Abstract
Objective: We investigated the clinical efficacy and safety of transvaginal ultrasound-guided aspiration in treatment of benign pelvic cyst. Methods: We analyzed medical records of the 343 women with pelvic cyst who underwent transvaginal ultrasound-guided aspiration between 1996 and 2004. We investigated the age, parity, tentative diagnosis, size of the cyst at short-, and long- term follow up, type of aspiration, character and cytology of the aspirated contents, and complication. Results: Mean diameters were significantly reduced after transvaginal ultrasound-guided aspiration at short-, and long-term follow up in all types of cysts except lymphocele (p<0.05). However, at long-term follow up, the proportions of the cysts that were completely resolved or reduced in size greater than 50% after ultrasound-guided aspiration were only 37%, 24.8%, 28%, and 30% in simple cyst, endometrioma, pseudocyst, and lymphocele, respectively. No serious aspiration related complication was identified except two cases. One was ovarian abscess and the other was bladder puncture during aspiration. Conclusion: This study suggests that transvaginal ultrasound-guided aspiration of benign pelvic cyst is a simple and safe procedure, but the application of aspiration to simple cyst, pseudocyst, lymphocele should be prudent because of the limited therapeutic efficacy. But for patients with endometrioma who wish to be pregnant, transvaginal ultrasound-guided aspiration could be a good treatment option to preserve ovarian reserve function.
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