자궁외임신의 최근 8년간의 임상적 고찰
A clinical study of ectopic pregnancy during recent 8 years
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목적: 자궁외임신에 대한 임상 및 역학적 특성을 분석하고 그 조기진단과 적정한 치료법을 확인하기 위해 본 연구를 시행하였다. 연구 방법: 2000년 1월부터 2007년 12월까지 한림대학교 의료원의 자궁외임신 환자의 의무기록지를 조사하였다. 결과: 자궁외임신의 빈도는 13.6개의 분만당 1건이었고 호발연령은 26~30세였다 (29.5%). 위험인자는 과거 복부나 골반수술 병력 (37.0%), 인공유산 병력 (30.8%) 골반염 병력 (12%), 난관불임술 병력 (9.6%) 순이었다. 증상은 무월경 (88.7%), 하복통 (81.2%), 질출혈 (60%) 순으로 나타났으며, 증상 발현은 마지막 생리시작일 후 6~8주가 47%로 가장 높은 빈도를 보였다. 혈색소는 10 gm/dL 이상이 79%였고 8 gm/dL 이하가 3.9%였다. 발생부위는 난관에 89%, 자궁각에 7.2%, 난소에 1.1%, 자궁경부에 2.7%였다. 수술은 복강경이 755예 (71.6%), 개복술이 273예 (25.9%), 소파수술이 26예 (2.5%)에서 행해졌다. 수술 시 난관 절제가 82.4%로 가장 많았고, Methotrexate (MTX) 치료는 13예 (1.21%)에서 성공적으로 행해졌다. 결론: 자궁외임신의 조기진단은 혈청 β-hCG와 질초음파를 함께 이용하는 것이 가장 유용하다고 생각되며 치료는 복강경수술이 개복술에 비해 입원기간 및 합병증을 낮출 수 있어 향후 치료에 더욱 중요한 역할을 하리라 생각된다.
Abstract
Objective: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. Methods: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. Results: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). Conclusion: The early diagnosis of ectopic pregnancy is most useful when serum β-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.
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