Comparison of Clinical Menifestations between Adolescents and Unmarried Young Women with Endometriosis in Daegu

대구 지역 청소년 및 미혼 여성 자궁내막증 환자의 임상 특성에 관한 비교연구

  • Kim, Yoon-Jeong (Department of Obstetrics and Gynecology, Kyungpook National University Hospital) ;
  • Choi, Min-Hye (Department of Obstetrics and Gynecology, Kyungpook National University Hospital) ;
  • Chung, Min-Ji (Department of Obstetrics and Gynecology, Kyungpook National University Hospital) ;
  • Lee, Jung-Ho (Department of Obstetrics and Gynecology, Keimyung University Hospital) ;
  • Lee, Taek-Hoo (Department of Obstetrics and Gynecology, Kyungpook National University Hospital)
  • 김윤정 (경북의대 산부인과학교실) ;
  • 최민혜 (경북의대 산부인과학교실) ;
  • 정민지 (경북의대 산부인과학교실) ;
  • 이정호 (계명의대 산부인과학교실) ;
  • 이택후 (경북의대 산부인과학교실)
  • Published : 2007.09.30

Abstract

Objective: The purpose of this study is to find out the differences of clinical characteristics of endometriosis and to emphasize the significance of early diagnosis of endometriosis to protect disease progression in adolescents. Methods: A retrospective analysis was carried out. All cases (n=130) were diagnosed surgically as endometriosis between January 2000 and August 2007 in two university hospitals in Daegu. Adolescents were 23 cases and unmarried young women were 107 cases. Data were collected through review of medical records. Results: The predominant symptom in adolescents was cyclic pain. 52.2% of adolescent patients were stage I or II. And stage III was 47.8% but stage IV was none. The other side 82.2% of unmarried young women patients were stage II or III and stage IV was 15.8%. Serum CA-125 level was elevated in adolescents, also. But there was no significant difference between the two groups. Conclusions: Endometriosis is progressive disease. Early diagnosis is necessary for prevention of the disease progression and free from pain. Appropriate gynecologic examination and careful concerns about adolescents are mandatory.

목 적: 본 연구는 청소년기와 성인 미혼 여성에서의 자궁내막증의 특징을 비교해 보고 청소년기에 조기 발견 및 치료의 중요성에 대해 알아보고자 한다. 연구방법: 000년 1월부터 2007년 9월까지 대구 소재 두 대학병원을 방문하여 수술을 시행한 환자를 대상으로 청소년 (14$\sim$21세, 23예)과 성인 미혼 여성 (22$\sim$26, 107예)의 자궁내막증의 임상양상, 진단과정, 수술소견, 혈액검사소견(CA-125) 등을 의무 기록 분석을 통한 후향적인 방법으로 비교하였다. 결 과: 대구 지역 청소년은 cyclic pain을 주증상으로 흔히 호소하였다. 청소년은 52.2%가 stage I, II였으며, stage III는 47.8%, stage 4는 없었다. 반면에 성인에서는 stage I이 1.86%에 불과하였으며, stage II 및 stage III가 82.2%로 대다수를 차지하였으며 stage IV도 15.8%차지하였다. 청소년에서도 CA-125가 상승되어 있는 경우가 많았고 이를 병의 경과 관찰에 이용할 수 있을 것이다. 청소년에서 순수 자궁내막증을 의심하여 수술한 경우는 전체 23예 중에 10예에 불과하였으며 이외 13예는 다른 진단으로 시행한 수술에서 우연히 발견되었다. 이는 전체 56.5%로 많은 비중을 차지하며, 성인 여성에서 27.5%에 불과한 것과는 대조적이다. 결 론: 대구 지역 청소년들을 대상으로 시행한 이번 연구에서는 청소년기에서 주기성 통증이 우세하였으며 이는 임상증상 만으로도 조기 발견에 도움이 될 수 있을 것이다. 자궁내막증은 진행하는 병임은 틀림없으므로 만성 골반통이 있는 청소년을 대상으로 적절한 산부인과적 검사를 통한 조기 진단 및 치료가 중요할 것으로 사료된다.

Keywords

References

  1. Rice VM. Conventional medical therapies for endometriosis. Ann NY Acad Sci 2002; 955: 343-52 https://doi.org/10.1111/j.1749-6632.2002.tb02795.x
  2. Vercellini P, Fedele L, Arcaini L, Bianchi S, Rognoni MT, Candiani GB. Laparoscopy in the diagnosis of chronic pelvic pain in adolescent women. J Reprod Med 1989; 34: 827-30
  3. Kontoravdis A, Hassan E, Hassiakos D, Botsis D, Kontoravdis N, Creatsos G. Laparoscopic evaluation and management of chronic pelvic pain during adolescence. Clin Exp Obstet Gynecol 1999; 26: 76-7
  4. Sangi-Haghpeykar H, Poindexter AN. Epidemiology of endometriosis among parous women. Obstet Gynecol 1995 85: 983-92 https://doi.org/10.1016/0029-7844(95)00074-2
  5. Reese KA, Reddy S, Rock JA. Endometriosis in an adolescent population: the Emory experience. J Pediatric Adolesc Gynecol 1996; 9: 125-8 https://doi.org/10.1016/S1083-3188(96)70021-9
  6. Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ. PreUAlence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol 1997; 10: 199-202 https://doi.org/10.1016/S1083-3188(97)70085-8
  7. Goldstein DP, De Cholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care 1980 Sep; 1(1): 37-41 https://doi.org/10.1016/S0197-0070(80)80007-6
  8. Chatman DL, Ward AB. Endometriosis in adolescents. J Reprod Med 1982 Mar; 27(3): 156-60
  9. Davis GD, Thillet E, Lindemann J. Clinical characteristics of adolescent endometriosis. J Adolesc Health 1993; 14: 362-8 https://doi.org/10.1016/S1054-139X(08)80008-0
  10. Demeo L. Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy. J Am Assoc Gynecol Laparosc 1998; 5: 241-5 https://doi.org/10.1016/S1074-3804(98)80026-1
  11. Revised American society for reprodective medicine classification of endometriosis: 1996. Fertil Steril 1997; 67: 817-21 https://doi.org/10.1016/S0015-0282(97)81391-X
  12. Pittaway DE, Fayez JA. The use of CA-125 in the diagnosis and management of endometriosis. Fertil Steril 1986; 46: 790 -5 https://doi.org/10.1016/S0015-0282(16)49812-2
  13. Sampson JL, Elias S, Malinak LR, Buttram VC. Heritable aspects of endometriosis. Am J Obstet Gynecol 1980; 137: 327-31 https://doi.org/10.1016/0002-9378(80)90917-5
  14. . Cook AS, Rock JA. The role of laparoscopy in the treatment of endometriosis. Fertil Steril 1991; 55: 663-80 https://doi.org/10.1016/S0015-0282(16)54228-9
  15. Sanfilippo JS, Wakim NG, Schilder KN, Yussman MA. Endometriosis in association with uterine anomaly. Am J Obstet Gynecol 1986; 154: 39-43 https://doi.org/10.1016/0002-9378(86)90389-3
  16. Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process. Fertil Steril 2002; 78: 961-72 https://doi.org/10.1016/S0015-0282(02)04216-4
  17. Sutton CJ, Ewan SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil Steril 1994; 62: 696-700 https://doi.org/10.1016/S0015-0282(16)56990-8
  18. Redwine DB. ConserUAtive laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertil Steril 1991; 56: 628 -34 https://doi.org/10.1016/S0015-0282(16)54591-9
  19. Sutton CJ, Pooley AS, Ewen SP, Haines P. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril 1997; 68: 1070-4 https://doi.org/10.1016/S0015-0282(97)00403-2