자궁내막종 적출술후 GnRH analogue의통증 치료 효과에 관한 고찰
The Efficacy of GnRH Analogue on Pain Treatment after LaparoscopicCystectomy of Endometrioma
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목적 : 보존적인 자궁내막종 통증 치료에 있어서 수술 골반경을 이용한 낭종 절제술후 GnRH analogues 병합 요법이 얼마나 기여하는가에 대해 알고자 하였다. 연구 방법 : 2000년 3월부터 2001년 2월까지 12개월 동안 전남대학교병원 산부인과 외래에서 자궁내막종으로 진단받고 수술 골반경을 이용한 낭종 절제술을 시행받은 환자 중 통증이 있는 65명의 환자를 대상으로 하였다. 이들은 수술 후 GnRH analogue를 매월 1회, 6개월 동안 근육 주사하였으며 병합 요법 시행 6개월 후와 12개월 후에 외래에서 치료 전후의 통증 정도를 비교 분석하였다. 결과 : 65명의 환자에서 총 96개의 자궁내막종 (21개는 양측성)이 발견되었다. 이 중 생리통은 40명, 성교통은 14명에서 있었고 생리와 관계없는 만성 골반통을 호소하는 환자가 24명이었다. 수술전과 병합 요법 시행 6개월, 12개월 후의 통증 점수를 비교한 결과 생리통은 수술전 5.85±2.28에서 병합 치료 6개월 후 3.20±1.68, 12개월 후 2.42±1.90였으며, 성교통은 수술전 5.29±1.49에서 병합 요법 후 6개월에는 3.71±1.73, 12개월 후에는 3.57±1.79이었고, 골반통은 수술전 5.33±2.10에서 치료 6개월 후 3.63±2.26, 12개월 후에는 3.29±1.97로 감소된 결과를 나타내었다. 결론 : 난소의 자궁내막종에 대한 치료로 수술골반경을 이용한 낭종 절제술을 시행한 다음 GnRH analogue 치료를 6개월 동안 병용한 후 통증의 정도가 수술전보다 감소되었다는 걸 확인할 수 있었다. 따라서 수술 후 GnRH analogue 병합요법이 자궁내막종 치료에 매우 도움이 되리라고 사료된다.
Abstract
Objective : To estimate the efficacy of GnRH analogue on pain treatment after laparoscopic cystectomy of endometrioma. Methods : During a 12-month period from March 2000 to February 2001 in Chonnam National University Hospital, Sixty five patients with ovarian cysts were diagnosed as endometrioma by clinical examination, ultrasonogram and serum CA 125 level. The laparoscopic cystectomy was performed and 65 consecutive women were biopsy-proved endometrioma. They were treated with GnRH analogue intramuscular injection every 4 weeks over a period of 6 months after operation. 10-point linear visual analogue scales for pelvic pain were completed pre- and post- treatment at 6 months and 12 months. Results : A total of 96 endometriotic cysts (21 cysts were bilateral) were found in the 65 patients. 65 patients had a pain associated with endometriosis. 40 patients of them complained of a dysmenorrhea, 14 patients for dyspareunia, and 24 patients for non-menstrual pain. At preoperative, the mean pain score was 5.85±2.28 (mean±SD) for dysmenorrhea; for dyspareunia, 5.29±1.49; for non-menstrual pain, 5.33±2.10. At 6 months and 12 months, the mean pain score was 3.20±1.68 and 2.42±1.9 for dysmenorrhea; for dyspareunia, 3.71±1.73 and 3.57±1.79; for non-menstrual pain, 3.63±2.26 and 3.29±1.97. The mean pain score for pelvic pain decreased after combined treatment. Conclusion : The laparoscopic cystectomy of ovarian endometrioma is an effective treatment for pelvic pain and the combination therapy with GnRH analogue is more useful to relieving pelvic pain after operation.
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