난소난관농양 환자의 수술적 중재를 결정짓는예측 인자
The Predictive Factors that Determines the Surgical Intervention in Tubo-Ovarian Abscess Patients
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목적 : 난소난관농양 환자의 치료에 있어서 내과적 그룹과 수술적 그룹간에 미치는 인자의 차이점을 알아보고, 내과적 치료보다 조기 수술이 더 효율적인 치료그룹이 어떤 그룹인지를 결정하기 위함이다. 연구 방법 : 1998년 2월부터 2003년 5월까지 동국대학교병원 산부인과에 난소난관농양의 진단하에 입원하여 치료한 85명을 대상으로 하여 내과적 치료군 (52명)과 수술적 치료군 (33명)을 분류하여, 이들의 의무기록을 토대로 역학적 요인과 임상 양상, 수술적 치료 등을 조사하여 각 군별로 통계학적 분석, 비교를 실시하였다. 결과 : 내과적 치료군과 수술적 치료군간의 영향인자를 보았을 때, 나이가 많거나 출산력이 높은 경우, 자궁내 피임장치를 사용하고 있는 경우, C-반응성 단백질이 높은 경우나 초음파 상 농양의 크기가 6 cm 이상인 경우 수술적 중재를 시행하는 경향이 더 많았다. 두 군간의 고열이나 백혈구 증가증, 기왕 골반염의 과거력, 양측성 농양 등의 인자들은 유의한 차이가 없었다. 결론 : 나이가 많거나 출산력이 많은 난소난관농양 환자에서 농양의 크기가 6 cm 이상 큰 경우와 자궁내 피임장치를 사용하거나 CRP가 높은 경우에는 내과적 치료에 반응하지 않을 가능성이 크므로, 상기 예후 인자를 참고하여 내과적 치료 외에 수술이나 중재적 시술을 동시에 시행하는 것이 치료기간을 단축시키고 치료지연으로 인한 합병증을 미리 예방하는데 도움이 되리라고 생각된다.
Abstract
Objective : To assess what are the predictive factors that differentiate between medical and surgical group and, to determine the group that can be treated more efficiently with early surgical intervention than with conservative medical management. Methods : Clinical and epidemiologic factors from the medical records of 85 selected patients who had either medical (n=52) or surgical (n=33) treatments for Tubo-ovarian abscess in Dongguk university hospital from February 1998 to May 2003 were evaluated retrospectively. Results : Prognosis was predictable on the basis of response to the medical therapy and the extent of the disease at the time of the diagnosis. There was apparent association with the age, parity factors and CRP values where higher the variables, surgical intervention was needed. Same results were obtained with the large size of the abscess according to the sonography and the usage of the intrauterine devices (p<0.005). No statistical significance was noted, however, with leukocytosis, ESR, previous PID or D&C history, or high body temperatures (all ranging p>0.05). Conclusion : Medical therapy in the patients with high parity or old age is most likely to fail if the size of the abscess is more than 6 cm, increased CRP value or using IUD as a contraceptive. These prognostic factors should be considered in the early surgical interventions to prevent the subsequent complications from the delay of treatments and also to reduce the duration.
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