Sturmdorf봉합법을 사용한 한랭식 원추절제술의 합병증
Complications of Sturmdorf's suture in cold knife conization
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목적 : 한랭식 원추절제술은 그동안 수술 후 출혈의 빈도가 높다고 여겨져 왔으며 출혈을 감소하기 위해 여러 방법이 제시되어 왔다. 본 연구의 목적은 Sturmdorf봉합법을 사용한 한랭식 원추절제술의 합병증을 조사하고 출혈을 감소하기 위해 사용한 여러 가지 방법을 알아보고자 함이다. 연구 방법 : 1997년 8월부터 2003년 7월까지 자궁경부 상피내종양을 진단 또는 치료하기 위해 한랭식 원추절제술을 시행 받은 85명의 환자의 결과를 조사하였다. 결과 : 총 85예 중 원추형 생검술 절제연에 병변이 침윤되지 않은 경우는 83예 (97.7%)이고 2예 (2.3%)에서 병변 침윤이 있었다. 54예의 경우 원추절제술 후 더 이상의 치료를 필요로 하지 않았고 합병증은 9예 (16.7%)에서 발생하였다. 그 가운데 지혈을 위해 추가적인 처치가 필요한 출혈은 7예 (13%)에서 일어났고 이들 중 치료를 위해 입원이 필요한 경우는 6예였고 1예는 외래에서 거즈압박만으로 치료가 가능하였다. 입원한 6예 중 2예는 근막외자궁절제술을 시행 받았고 1예는 전기응고술로 지혈하였다. 1예는 수혈을 받았고 2예는 거즈압박을 시행 받았다. 감염은 2예 (3.7%)에서 발생하였고 그 외 다른 합병증은 없었다. 결론 : Sturmdorf봉합법을 사용한 한랭식 원추절제술은 며칠간의 입원이 필요하고 다른 대체적인 치료 방법이 편리함에도 불구하고 자궁경부 상피내종양을 치료하는데 비교적 적은 합병증으로 좀 더 정확한 조직 결과를 얻을 수 있다.
Abstract
Objective : It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorfʼs suture in cold knife conization and to investigate various measures employed to reduce blood loss. Methods : The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. Results : Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. Conclusion : Cold knife conization using Sturmdorfʼs suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several daysʼ admission is needed and the other alternative methods seem to be more convenient.
참고문헌 (17)
- "Intraepithelial Disease of the Cervix,Vagina,and Vul", pp.486~492 (2002), Lippincott Williams & Wilkins
- "Colposcopy Cervical Pathology. 3rd ed", pp.276~284 (1998), Thieme
- "Cone biopsy in the management of cervical intraepithelial neoplasia", 26, pp.968~979 (1983)
- "Diagnostic significance and sequelae of cone biopsy", 143, pp.312~315 (1982)
- "Bloodless technique of cold knife conization (ring biopsy)", 79, pp.62~66 (1960)
- "Cold conization of the cervix:Practical technique for maximum hemostasis", 15, pp.396~400 (1960)
- "Pitressin hemostasis in conization biopsy of the cervix", 30, pp.70~75 (1967)
- "Influence of the size of cone specimens on postoperative hemorrhage", 122, pp.939~944 (1975)
- "Incomplete excision of CIN in conization: further excision or conservative management?", 53, pp.45~47 (1994)
- "Surgical Gynecologic Oncology", pp.269~274 (1993), Thieme Medical Publishers
- "Atlas of Vaginal Surgery: Surgical anatomy and technique", pp.564~571 (1975)
- "Atlas of Gynecological Surgery. 2nd ed", pp.20~23 (1985), Thieme-Stratton Inc
- "Atlas of Gynecological Surgery. 3rd ed", pp.22~26 (1997), Thieme
- "Gynaecology and Obstetrics, Operative Surgery 4th ed", pp.45~51 (1987), Butterworths
- "A Randomized Prospective Study Comparing Three Techniques of Conization: Cold Knife, Laser, and LEEP", 54, pp.175~179 (1994)
- "Preoperative Evaluation and Postoperative Management", pp.569~643 (2002), Lippincott Williams & Wilkins
- "Large-loop excision of the transformation zone: effect on the pathologic interpretation of resection margins", 81, pp.976~982 (1993)