자궁외 임신에 대한 임상 통계학적 고찰

Abstract

[한글]1965년 1월 1일부터 1975년 6월 30일까지 연세대학교부속병원에 입원가료한 총 859예의 자궁외임신에 대하여 임상적 및 통계학적으로 분석고찰하여 다음 결과를 얻었다.

1. 자궁외임신의 분만수에 대한 빈도는 1:22였다.

2. 총 환자의 39.8%가 자연유산을, 54.6%가 인공유산을 한 경험이 있었다.

3. 불임기간은 평균 3년 11개월이었고, 9년이상이 11.6%이었다.

4. 기왕력에서 반복자궁외임신(12.6%)을 포함한 개복수술은 22%였고 골반내염증(4%)을 포함한 염증성질환은 19.1%였다.

5. 증상은 하복부복통, 성기출혈, 중압감, 오심, 구토, 현기증 등이었고 하복부압통이 89.6%, 내진시부속기종류가 53.6%에서 있었다.

6. 최종월경과 증상까지의 기간은 평균 6.8주 이었다.

7. 더글라스와 천자는 95.9%에서 적중하였다.

8. 착상부위는 난관 93.9%, 난소 1.6%, 잔류 자궁각 3.7%, 복막 0.5%, 자궁경부가 0.4%이었다. 난관임신에서는 팽대부 71.1%, 난관채 17.4%, 협부 10.8%, 간질부 0.7%이었다.

9. 중절은 파열 64%, 유산 33%, 무상 3.0%였다.

10. 자궁내막의 아리아스-스텔라씨 반응은 23.9%에서 나타났다.

11. 기간중 사망자는 한명도 없었다.

[영문]This study was undertaken for the clinical evalation and statistical analysis on the 859 women wish ectopic pregnancies who were admitted and treated at the Yonsei University Medical Center from Jan. 1, 1965 to June 30. 1975.

The following features were the results of the study :

1. Hospital incidence of ectopic pregnancy was 1 in 22 deliveries.

2. Ectopic gestation was found to occur most frequently in the age group, ranging from 25 to 34 years (60.2%)

3. Nulligravida wart 5.3%, nullipara 25.7% and multipara 56.4% of total.

4. Average Length of sterility was 3 years 11 Months and 11.6% (72 cases) had 9 years or more of sterility.

5. Histories of previous artificial and spontaneous abortion were noted in 54.6% and 39.8% respectively.

6. 186 cases 922%) had previous abdominal surgeries. Among them, 108 cases were repeated ectopic pregnancies and 48 cases were appendectomies.

Pelvic tuberculosis was noted in 2.5% (21 cases) Vaginitis, cervicitis and pelvic inflammatory disease was detected in 3.8% (33 cases), 1.1% (9 cases) and 4% (34 cases) respectively.

7. On symtomatology, lower abdominal pain was encountered in 91.5% (78 cases), viginal bleeding or spotting in 73.1% (628 cases), bearing down sensation in 16.0% (138 cases), nausea and vomiting in 14.4% (124 cases), fainting in 12.9% (111 cases), and shoulder pain in 14 cases.

8. Adnexal mass, usually tender, was palpated in 58.6% (450 cases) and lower abdminal tenderness was noted in 89.6% (752 cases), 58.2% (488 cases) complained of pain on mortion of cervix and 15.5% (130 cases) had abdominal rigidity.

9. The average interval between L.N.M.P. and onset of symptoms was 6.8 weeks.

10. W.B.C. count was considerably increased in ruptured cases.

11. Culdocentesis was carried in 605 cases and revealed 95.9% of accuracy rate.

12. Ectopic gestation was implanted on tube in 93.9% (interstitial portion ; 0.7%, isthmic p.; 10.8%, ampullar p.; 71.1%, fimbrial p.; 17.4%) on ovary in 1.6%, on uterine cornus in 3.7%, on peritoneum in 0.5%, and on cervix in 0.4%.

13. Tubal pregnancies were terminated by rupture in 64%, by abortion in 33% and intact type was 3.0%.

14. 80.8% of total cases were treated by salpingectomy, 17.5% by salpingo-oophorectomy and 1.7% by tuboplasty. Ligation of opposite tube was performed in 221 cases, appendectomy in 120 cases, cormual resection in 128 cases and hysterectomy in 67 cases.

15. Pathological findings of endometrium showed Ariass-stella reaction in 23.9%, decidualreaction in 31.2%, proliferative phase in 23.9% and secretory phase in 17.4%.

16. Of 859 total cases, no death occured.