• Radiation Oncology Journal
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• 제15권3호
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• pp.251-254
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• 1997

목적 : 침윤성자궁경부암에서 단순자궁적출술을 시행하는 것은 통상적인 치료원칙에 배치된다. 본 연구는 침윤성자궁경부암에서 단순자궁적출술이 시행되었을 경우 방사선치료의 역할을 확인하기 위하여 시행되었다. 대상 및 방법 :침윤성자궁경부암환자로서 단순자궁적출을 시행받고 1989년 4월부터 1993년 12월까지 경상대학교병원 치료방사선과에서 방사선치료를 시행받은 19명의 환자를 대상으로 후향적 분석을 시행하였다. 연구대상의 연령의 중앙값은 49세이었고, 연구대상에 대한 추적기간의 중앙간은 46개월이었다. 방사선치료는 17명에서는 외부방사선조사만 시행되었고 절제연에 잔류암이 있었던 2명에서는 강내치료를 병용하였다. 결과 : 전체 4년 생존율은 $75\%$이었고, 4년 국소제어율은 $89\%$이었다. 2명에서 국소 및 원격재발이 있었고 2명에서 원격재발이 있었다. 결론 : 침윤성 자궁경부암에서 단순자궁적출술이 시행된 경우 방사선치료는 매우 적절한 후속조치가 됨을 확인할 수 있었다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4525-4529
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• 2012

Objectives: To determine the prevalence and predicting factors of ovarian metastasis, and evaluate the histology of other ovarian neoplasms in women with early-stage cervical cancer. Methods: The medical records of women with cervical cancer stage IA-IIA who underwent primary surgical treatment at Siriraj Hospital, Mahidol University from January 2007 to December 2011 were used for the study. Demographic, clinical and histopathologic data of the women who underwent salpingo-oophorectomy were reviewed. Results: Of 264 women, the mean age was 52.3 years. The types of hysterectomy procedures were composed of 210 radical hysterectomy, 9 modified radical hysterectomy, 40 simple hysterectomy, and 5 abandoned hysterectomy. The prevalence of ovarian metastasis was 0.76% (2/264). All of ovarian metastatic patients were older than 60 years old, postmenopause, and had macroscopical stage IB1 cervical cancer. Others ovarian tumors were found in 7 patients including 1 synchronous ovarian carcinoma, 1 serous cystadenoma, 1 fibroma, and 4 teratoma. Conclusions: In cases of early-stage cervical carcinoma of the population studied, ovarian preservation could be another option in <60-year-old patients, with non-neuroendocrine cell type, stage IA, and no extracervical or ovarian lesions.

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5375-5378
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• 2013

Background: This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomy or radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors (nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at least cervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identify factors associated with median survival. At the median follow up time of 73 months, the 5-year disease-free survival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelvic lymph node metastases. In a univariate analysis, there was no statistically significant association between survival and prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin status and lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent. No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treated with simple or less radical hysterectomy with pelvic lymphadenectomy.

• Radiation Oncology Journal
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• 제21권3호
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• pp.199-206
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• 2003

목적: 자궁경부암에서 수술 후 위험인자가 있는 환자에 방사선치료 후 생존율, 국소 제어율과 예후인자를 후향적으로 분석하여 수술 후 방사선치료의 효과를 알고자 한다. 대상 및 방법: 1986년 3월부터 1998년 12월까지 자궁경부암 FIGO 병기 IB-IIB로 자궁적출술 후 방사선치료를 받은 58명을 대상으로 국소 제어율, 5년 무병생존율과 생존율에 미치는 예후인자를 후향적으로 분석하였다. 수술 후 방사선치료의 적응증은 병리학적으로 림프절에 전이된 경우, 암이 수술절제연이나, 자궁주위조직 혹은 자궁체부에 침범하였거나, 림프혈관강에 침범된 경우, 자궁기질의 1/2 이상 깊이 침윤된 경우와 단순 자궁적출술 후 암으로 진단받은 환자로 하였다. 수술 후 방사선치료는 모든 환자에서 골반강에 외부조사를 시행하였으며 5명은 외부조사와 강내조사를 병용하였다. 외부조사는 6 MV x-선을 이용하여 매일 180 cGy를 4문으로 조사하였으며 총 방사선량은 $4400\~5040$ cGy (중앙값: 5040 cGy)이었다. 강내조사는 외부조사 후 2주에 Cs-137를 이용하여 저선량률로 질 표면에서 5 mm 깊이에 $4488\~4932$ cGy (중앙값: 4500 cGy)를 시행하였다. 추적기간은 15개월에서 108개월로 중앙값은 44개월 이었다. 결과: 전체환자의 5년 무병생존율은 $94\%$, 국소 제어율은 $98\%$,이었으며 원격 전이율은 $5\%$이었다. 병기에 따른 5년 무병생존율은 $IB\;97.1\%,\;IIA\;100\%,\;IIB\;68.9\%$(p=0.0145)이었다. 질 절제연에 암의 침범이 없는 경우 5년 무병생존율이 $97.8\%$, 있는 경우 $60\%$, (P=0.0002)이었으며, 자궁주위조직에 암이 침범이 없는 경우의 5년 무병 생존율은 $97.8\%$이었고, 있는 경우는 $33.3\%$이었다(p=0.0001). 다변량 분석에 의하면 자궁주위조직의 침범만이 통계학적으로 의의있는 예후인자이었다. 치료 후 만성합병증은 3명($5\%$,)에서 RTOG grade 2의 방광염, 1명에서 grade 2의 직장염과 1명에서 하지에 림프부종이 나타났다. 결론: 조기 자궁경부암 환자에 단순 자궁적출술을 시행하였거나, 근치적 자궁적출술 후 병리학적으로 재발 위험 인자가 있는 환자에 수술 후 방사선치료를 시행하여 심각한 부작용 없이 비교적 높은 국소 제어율과 생존율을 얻을 수 있었다. 생존율에 영향을 미치는 예후인자는 병리학적으로 암이 자궁주위조직에 침범된 것으로 예후가 불량하였다. 수술 후 방사선치료의 실패원인과 예후인자를 분석한 본 후향적 연구결과를 토대로 앞으로 방사선치료와 항암화학요법을 병용하여 보다 적극적이고 전향적인 연구를 시도하는데 이정표로 이용할 수 있다고 생각한다.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.329-332
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• 2011

Purpose: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. Methods: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. Results: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. Conclusion: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.1035-1039
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• 2014

Aim: To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure (LEEP) in cases with cervical neoplasia. Materials and Methods: A retrospective cohort study was conducted on patients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, Mahidol University, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEP patients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who were treated with only LEEP. Results: There were 407 patients undergoing LEEP; their mean age was $39.7{\pm}10.5$ years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ${\leq}CIN$ I, 295 patients (72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in 15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwent hysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven (2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, and five had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) or simple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved with the lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of 99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages - one of which was due to an incompetent cervix. Conclusions: LEEP for patients with cervical neoplasia delivers favorable surgical, oncologic and obstetric outcomes.

• 대한한방부인과학회지
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• 제22권4호
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• pp.157-172
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• 2009

Purpose: The purpose of this study is to analyze the status of cooperative treatment of western-oriental medicine in post gynecological surgery. Methods: This study is conducted by investigating the hospitalized patient's medical chart and OCS dated from March 2008 to May 2009 in obstetrics and gynecology of oriental medicine department in Dong-Eui medical center. The total patient number was 58. Results: Out of 58 women, 74.1% complained abdominal pain and discomfort, 24.1% complained headache and dizziness, 22.4% complained lumbago, 22.4% complained lethargy and fatigue. There were 63.8% women in the age group between 41 to 50 and 20.7% women in the age group between 31 to 40. 53.4% women hospitalized for less than 7 days, 43.1% women hospitalized for 8 to 14 days. 53.4% had uterine myoma, 20.7% had more than two types of complex diseases and 19.0% had adenomyosis uterine. 60.3% had total hysterectomy and 27.6% had simple hysterectomy. 64.9% had abdominal surgery, 17.5% had laparoscope surgery and 15.8% had hysteroscope surgery. 62.8% of 43 women complained abdominal pain and discomfort, 78.6% of 14 women complained headache and dizziness, 46.2% of 13 women complained lumbago, 84.6% of 13 women complained lethargy and fatigue improved to VAS 0-3. Conclusion: The results has shown that it is necessary to have cooperative treatment of both western-oriental medicine for the effective treatment in managing post gynecological surgery. The further study in data collection and manual development is needed.

• The Korean Journal of Pain
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• 제11권2호
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• pp.230-234
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• 1998

Background: Continuous epidural block is widely used for surgical operation and postoperative pain management. The potential infection due to the epidural catheter is a definite harzard of continous epidural block. We investigated the effectiveness of bacterial filter in prevention of infection due to the epidural catheter. Methods: Patients scheduled for transabdominal hysterectomy were assigned to two groups by simple randomization (50 patients per group). All catheters were placed in the 2nd and 3rd lumbar epidural space, using careful sterile technique. Group 1 received injections by the epidural catheter with a bacterial filter and group 2 received injections by the epidural catheter without a bacterial filter. The infection rate in the tips of epidural catheter left for 3 days were compared between the two groups. Results: There was no significant difference in the infection rate between two groups. Conclusions: A bacterial filter of the epidural catheter for surgical anesthesia and postoperative analgesia dose not prevent all kinds of infection in continuous epidural block.

• Clinical and Experimental Reproductive Medicine
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• 제42권3호
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• pp.126-129
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• 2015

Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6691-6696
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• 2015

Background: Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. Materials and Methods: Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes = SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study. Results: Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken. Conclusions: SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.