자궁내막 과다증식증의 임상 및 병리학적 연구

Abstract

[한글]

자궁내막 과다증식은 병리학적 임상학적으로 중요한데 이상자궁출혈의 원인이 되며 자궁내막선암의 전단계라고 한다. 또한 미경산부, 비만증환자, 고혈압환자, 당뇨병환자, 골반합병증, 자궁근종, 자궁선근종, 난소의 난포홀몬 분비 종양, 기타 - 환자들, 등에서 합병율이 높으며 난포홀몬 과다증이 원인이 된다고 한다.

이에 1968년 1월부터 1977년 12월말까지 만10년간 연세대학교 의과대학 세브란스병원 산부인과에서 치료받은 환자들 중 조직학상 자궁내막 과다증식증으로 진단된 233예를 대상으로 임상 및 병리학적 연구를 하여 다음과 같은 결과를 얻었다.

1. 어느 연령에서나 발생할 수 있으나 40대에 112예(48.1%)로 가장 많은 분포를 보였으며 최소년령은 13세, 최고년령은 72세로 평균년령은 45.2세 이었다.

2. 주증상은 이상자궁출혈이 가장 많었으며 폐경기전 이상월경이 91.7%, 폐경기후 자궁출혈이 82.7%이었다.

3. 진단 방법은 소파술이 162예(69.5%)로 가장 많이 시행하였다.

4. 미경산부가 32명(13.7%), 비만환자가 102명(43.8%), 고혈압환자가 104명(44.7%)이었으며, 당뇨병환자가 7명, 갑상선질환자가 3명, 간장질환자가 5명이었다.

5. 골반내 합병증들은 자궁근종이 126예(54%), 자궁선근종 46예(26.8%), 기능성자궁출혈 37예(22.3%), 순이었다.

6. 난포홀몬 투여력은 16예(6.9%) 밖에 알 수가 없었다.

7. 조직학적 형태의 분류는 선종성 자궁내막 과다증식증이 176예(75.5%)로 가장 많았으며, 낭포성 자궁내막 과다증식증이 63예(27%), 낭포성 및 선종성 자궁내막 과다증식이 31예(13.3%), 이형 자궁내막 과다증식증이 13예(5.6%) 이었으며, 조직학적 형태 분류가 불확실한 경우가 12예(5.2%)이었다.

8. 폐경기전 자궁내막 과다증식증들 중 29.7%에서 난소의 황체가 발견되었고, 22%에서 여포나 여포낭이 보였다.

난소의 기질세포의 증식은 폐경기전 자궁내막 과다증식증들중 27.5%, 폐경기후 자궁내막 과다증식증들중 50%에서 보였다.

난소의 과립막-포막세포암이 2예, Stein Leventhal 증후군이 3예이었다.

9. 치료는 대부분 자궁적출술을 시행하여 166예(71.2%)이었는데 이들중 다른 골반내 합병증들 때문에 자궁적출술을 시행하였던 경우가 64예(27.5%)이었다.

[영문]

Among the many points to be considered in apprasing the clinical and pathological importance of endometrial hyperplasia are its role in excessive uterine bleeding, which it be functional or that associated with pelvic lesions, its relation to nulliparity, obesity, hypertension, diabetes mellitus, hyperestrogenism, combined pelvic pathology. its occurrence before or after menopause, and the part it plays in the development of fundal malignancy.

The cases for this study consist of 233 patients of endometrial hyperplasia who were admitted to the department of obstetrics and Gynecology of the Severance Hospital of the University of Yonsei. They are divided into two groups, the premenopausal comprising 181 patients and the postmenopausal of 52.

The results were as follows:

1) The peak incidence occurred in the fifth decade of life with 112 patients (48.1%) and the average age was 45.2 years. The youngest patient was 13 years of age, the oldest 72 years of age. The average age at the onset of postmenopausal bleeding was 52.5 years, the last menstrual period was at an average of 49.8 years.

2) The menstrual abnormalities, which occurred memorrhagia in 40.8%, metrorrhagia in 22.1%, menometrorrhagia in 167, etc. were noted in 166 cases of the premenopausal group (91.7%) and the postmenopausal bleeding in 43 cases of all postmenopausal group (82.7%).

3) All specimens for the pathological study were obtained by hysterectomy in 162 cases, dilatation and curettage in 64 cases, endometrial biopsy in 7 Cases.

4) In 104 patients of this series (44.7%), the blood pressure exceeded 140/90 mm Hg, which would seem to be considerably higher than the expected level for this age group.

102 patients of these women (43.8%) were obese using an abitrary criterion of over 20% of the Korean adult female standard body weight(=0.56 x height(cm) - 38) (kg). On accasion the exact weight was not noted in the history, but the patient

was considered obese if the examiner's note specially so stated.

32 patients of these women (13.7%) were nulliparous and 7 cases of them had primary infertility.

5) 16 cases of the entire group (6.9%) were noted to have received estrogen preperations of one kind or another before the onset of vaginal bleeding.

6) These cases were classified as adenomatous endometrial hyperplasia in 176 cases (75.5%), cystic endometrial hyperplasia in 63 cases (27%), atypical endometrial hyperplasia in 13 cases (5.6%), undetermined endometrial hyperplasia in 12 cases (5.2%), by the pathological type.

7) In this series, myoma in 54 cases (32.5%), adenomyosis in 40 cases (26.8%), dysfunctional uterine bleeding in 37 cases (23.5%) were presented and corpus lutea were found in 29.7% of the premenopausal group and follicular cysts or cystic follicles in 23%.

The ovarian stromal hyperplasia was noted in 50% of the postmenopausal group and Stein Levendal syndrome in 3 cases and granulosa-theca cell tumor in 2 cases were found.

8) Simple hysterectomy was the most frequently performed major operation with 166 cases (71.2%), but in these cases, incidental hysterectomy for other pelvic lesions was included in 64 cases (27.5%).