자궁비대가 있는 여성에서의 질식자궁적출술
The Vaginal Hysterectomy for the Woman with Uterine Enlargement
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적 : 본 연구의 목적은 질식자궁적출술을 시행함에 있어 자궁무게와 수술성적간의 관계를 평가함으로서 자궁비대가 있는 여성에서의 질식자궁적출술의 안전성과 효율성을 밝히고자 함에 있다. 연구 방법 : 2001년 2월부터 2003년 11월까지 본원에서 질식자궁적출술을 시행한 170명의 화자들을 자궁무게가 300 gm에서 1000 gm 사이인 40명 (GroupⅠ)과 자궁무게가 300 gm 미만인 130명 (GroupⅡ)으로 나누어 분류하여, 각각 의무 기록지를 통해 연령, 분만력, 자궁무게, 수술기왕력, 동반수술, 수술 후 입원기간, 출혈량, 수술 전 후 헤모글로빈 변화, 수술시간, 합병증을 비교분석 하였다. 결과 : 임상적 분석의 결과 두 집단간의 연령, 분만력, 수술기왕력, 수술 후 입원기간, 동반수술, 출혈량, 수술 전 후 헤모글로빈 변화 비교에서는 유의한 차이가 없었으며, 수술 합병증 발생률의 비교에서도 GroupⅠ에서 12.5%, GroupⅡ에서 13.1%로 유의한 차이는 없었다 (P=.660). 수술시간의 비교에서는 GroupⅠ에서 Group Ⅱ에서 보다 평균 16분 가량 수술시간이 더 소요되었으나 통계학적 유의성은 없는 것으로 나타났다 (GroupⅠ 78.4±27.1분; GroupⅡ 62.9±22.7분) (P=.176). 결론 : 자궁무게가 300 gm과 1000 gm 사이로 자궁비대가 있는 여성에서의 질식자궁적출술은 자궁무게가 300 gm 미만인 경우와 비교하여 안정성 및 효율성에 차이가 없었으며, 자궁비대가 질식자궁적출술의 금기증이 되지 않으며, 자궁세정술 (morcellation)을 능숙하게 사용함으로서 수술시간을 줄일 수 있을 뿐 아니라 더욱 안전하게 질식자궁적출술을 시행할 수 있을 거라 사료된다.
Abstract
Objective : The purpose of this study was to evaluate the relationship between uterine size and surgical outcomes in women undergoing total vaginal hysterectomy. Methods : We reviewed the medical records of the 170 patients who underwent total vaginal hysterectomy from February 2001 to November 2003. These patients were stratified into two groups; GroupⅠ, patients with uterine weight of between 300 gm to 1000 gm; GroupⅡ, patients with uterine weight of <300 gm. The two groups were compared for ages, parity, uterine weight, previous abdominal operations, concurrent surgical procedures, postoperative discharge day, bleeding amount, perioperative hemoglobin concentration change and operative time. Results : 1. There were no significant difference between the two groups with respect to postoperative discharge day, concurrent surgical procedures, bleeding amount and perioperative hemoglobin concentration change. 2. The rate of surgical complications were similar in the two groups (GroupⅠ 12.5%; GroupⅡ 13.1%) (P=.660). 3. Operative time for vaginal hysterectomy was slightly longer for women in GroupⅠ than GroupⅡ (GroupⅠ 78.4±27.1 minutes; GroupⅡ 62.9±22.7 minutes) (P=.176), but the difference between the two groups in operative time was not statistically significant. Conclusion : The vaginal hysterectomy is as safe and effective for the woman with enlarged uterus (300-1000 gm) as for the woman with uterine weight of <300 gm. Uterine enlargement (uterine weight>300 gm) is not an absolute contraindication to vaginal hysterectomy.
참고문헌 (28)
- Seen N, "The early history of vaginal hysterectomy", 25, pp.47~ (1985)
- Bachmann GA, "Hysterectomy:A clinical review", 35, pp.839~ (1990)
- Stovall TG, "Randomized comparison of laparoscopy assisted vaginal hysterectomy with standard vaginal vaginal hysterectomy with in and outpatient setting", 80, pp.895~901 (1992)
- Munro MG, "Laparoscopic hysterectomy: does it work?: A bicontinental Review of the Literature and Clinical Commentary", 38, pp.401~424 (1995)
- 김종렬, "골반내 수술 기왕력이 있는 환자에서 질식자 궁적출술 212예의 임상적 특성 및 수술기법에 관한 연구", 42, pp.1713~1719 (1999)
- Villard-Mackintosh L, "The epidemiology of hysterectomy:findings in a large cohort study", 99, pp.402~407 (1992)
- Greenspan JR, "Complications of abdominal and vaginal hysterectomy among women of reproductive age in United states:The collaborative Review of Sterilization", 144, pp.841~848 (1982)
- Nichols DH, "Vaginal surgery" (1996), Williams & Wilkins
- Stovall TG, "vaginal, abdominal, and laparoscopic assisted hysterectomy. In:Gynecologic surgery", pp.403~444 (1996), Churchill Livingstone
- Reiffenstuhl G, "Vaginal operations- surgical anatomy and technique" (1996), Williams & Wilkins
- Lash AF, "A method for reducing the size of the uterus in vaginal hysterectomy", 42, pp.452~459 (1941)
- Unger JB, "Vaginal hysterectomy for women with a moderate enlarged uterus weighing 200 to 700 gm", 180, pp.1337~1344 (1999)
- Kammerer-Doak D, "Vaginal hysterectomy with and without morcellation: the University of New Mexico Hospital's experience", 188, pp.560~563 (1996)
- Mazdisnian F, "Vaginal hysterectomy by uterine morcellation: an efficient, non-morbid procedure", 86, pp.60~64 (1995)
- Carlson KJ, "The Maine Women's Health Study. I. Outcomes of hysterectomy", 83, pp.556~565 (1994)
- Black N, "Indications for outcome of total abdominal hysterectomy for benign disease:a prospective cohort study", 102, pp.611~620 (1995)
- Unger, "Vaginal hysterectomy in women with history of previous cesarean delivery", 179, pp.1473~1478 (1998)
- Kadar N, "Laparoscopically assisted vaginal hysterectomy for uteri weighing 500 g or more", 1, pp.405~409 (1994)
- Dimino M, "Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy", 3, pp.585~587 (1996)
- Nugent EW, "Complications and recovery from LAVH compared with abdominal and vaginal hysterectomy", 89, pp.304~308 (1997)
- Bournas N, "Vaginal hysterectomy for the large uterus", 103, pp.246~251 (1996)
- Unger JB, "The extraperitoneal approach to vaginal hysterectomy", 3, pp.240~245 (1997)
- Krige CF, "Vaginal hysterectomy and genital prolapse repair" (1965), Witwatersrand University Press
- Ling FW, "A randomized trial evaluating leuprolide acetate prior to hysterectomy as treatment for leiomyoma", 164, pp.1420~1425 (1991)
- 이선경, "자궁탈출증을 제외한 질식자궁적출술 114예의 임상적 고찰", 41, pp.1155~1160 (1998)
- Feroze RM, "Vaginal hysterectomy and repair", 5, pp.545~556 (1978)
- Porges RF, "Changing indications for vaginal hysterectomy", 136, pp.153~158 (1980)
- 이윤순, "질식자궁적출술의 임상적 시도", 38, pp.1860~1870 (1995)