ORIGINAL ARTICLE Korean J Obstet Gynecol 2012;55(12): pissn eissn EFFICACY OF

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1 ORIGINAL ARTICLE Korean J Obstet Gynecol 2012;55(12): pissn eissn EFFICACY OF SURGICAL TREATMENT FOR SUCCESSFUL PREGNANCY IN INFERTILE PATIENTS WITH HYDROSALPINX Ju Youn Bae, MD, Hwa Seon Koo, MD, Yu Im Hwang, MD, Chan Woo Park, MD, Sun Hwa Cha, MD, Kwang Moon Yang, MD Department of Obstetrics and Gynecology, Cheil General Hospital and Women s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea Objective The aim of this study is to evaluate the efficacy of surgical treatment in patients with hydrosalpinx on the success of the pregnancy. Methods We retrospectively analyzed the medical records of 65 patients who were diagnosed to hydrosalpinx by hysterosalpingogram. Among 65 patients who diagnosed to hydrosalpinx, 38 patients were received surgical treatment (surgical treatment group). Otherwise, 27 patients didn t received any surgical treatment and classified as no treatment group. After then, surgical treatment group was subgrouped into two groups according to their method of surgery such as salpingoneostomy group (n = 29) and salpingectomy group (n = 9). Then we analyzed several factors related to pregnancy of each group. Results There were no statistically significant differences in age, duration of infertility, fertility history and causes of infertility between groups. The in vitro fertilization (IVF) success rate in salpingectomy group (77.8%) was significantly higher than that of no treatment group (34.8%) (P=0.035). Conclusion In infertile patients with hydrosalpinx, surgical treatment of hydrosalpinx seems to have beneficial effects to increase the success rate of pregnancy through IVF. Keywords: Infertility; Salpingoneostomy; Salpingectomy; Pregnancy rate; In vitro fertilization 불임의원인에는남성측요인이 50%, 여성측요인이 50% 가되고, 이중여성측요인을좀더세분화해보면배란장애와난관또는복강내요인이각각 30%-40% 를차지하고있다. 여성측난관요인으로인한불임의주요원인으로보고되고있는난관수종은골반강수술력, 골반염증성질환의과거력, 자궁내막증, 복막염의과거력등이있는경우정상난관에유착이생기면서난관채가막히게되고, 난관내강의세포가분비하는액이폐색된난관내에고이게되면서원위부난관이팽창하여발생하게된다 [1]. 이런난관수종은일차로는폐색된난관으로인한난자의포획을방해하고, 또난관수종내에고인난관수종액이수정란의착상과배아의성장에부정적인영향을주어불임을야기한다. 이것은난관수종이있는환자에서체외수정시술의임신성공률이현저하게낮았다는대규모의메타분석연구결과로뒷받침될수있다 [1]. 난관수종은나팔관조영술이나진단적복강경검사등으로난관의폐 Received: Revised: Accepted: Corresponding author: Kwang Moon Yang, MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women s Healthcare Center, Kwandong University College of Medicine, 17 Seoae-ro 1-gil, Jung-gu, Seoul , Korea Tel: Fax: km1yang@naver.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright Korean Society of Obstetrics and Gynecology 929

2 KJOG Vol. 55, No. 12, 2012 쇄를진단할수있으며, 진단된난관수종으로인한불임의치료로난관신개구술로폐쇄부위를재개통하여자연적인임신을기대할수있고, 체외수정시술을통해임신을시도하는방법이있다. 최근에는체외수정시술의성공률이상승하여수술적치료없이바로체외수정시술을시도해볼수있으나, 난관수종이있으면체외수정시술의성공률이절반정도로감소하고유산율은두배정도로증가한다는연구결과가보고된바있어 [1,2], 난관수종이있는환자는체외수정시술전에난관절제술을먼저하는것을고려해볼필요가있다. 난관수종의수술적치료후체외수정시술시결과가향상된다는연구결과들이보고되었는데, 난관수종이있는경우체외수정시술전에난관수종을치료하면임신율및착상률을증가시킨다는연구결과가있었고 [3], 난관수종을절제한후에체외수정시술을하면, 임상적임신율이 60% 로치료하지않은군에비교하여통계학적으로의미있게높게나타났다는보고가있었다 [4]. 또, 체외수정시술을하기전에난관수종액을외과적으로배액시켜준경우에도임신율이향상되었다는보고가있었다 [5]. 하지만이런난관절제술이오히려난소로향하는혈류량을감소시키거나난관의유착을일으켜임신성공률이감소한다는연구결과도있다 [6]. 이에저자들은난관수종이원인이되는불임환자에서의난관수종에대한수술적치료방법즉, 난관신개구술 (salpingoneostomy) 이나난관절제술 (salpingectomy) 후체외수정시술을통한임신의시도또는자연임신의시도에대하여임신성공률등을분석하여난관수종의수술적치료방법이임신의성공에미치는영향을연구해보고자하였다. 연구대상및방법 본연구는 2006년 1월부터 2009년 12월까지 48개월동안불임을주소로본원에내원하여자궁난관조영술검사또는진단적복강경검사로난관수종을진단받은불임환자들을대상으로하였다. 연구기간동안난관수종을진단받은불임환자는모두 106명이었으며이중추적관찰에실패한 40명과진단적복강경검사에서정상이었던 1명을제외한 65명의난관수종환자들을대상으로하여임신을위한치료및임신과관련된의무기록을후향적으로분석하였다. 복강경검사시난관의개통성여부는난관통색소법으로검사하였다. 65명의환자들을난관조영술검사또는진단적복강경검사로난관수종을진단받았으나, 난관수종의수술적인치료는받지않은군 (27명) 과수술적인치료를받은군 (38명) 으로나누었고, 후자를수술의방법즉, 난관신개구술을받은군 (29명) 과난관절제술을받은군 (9명) 으로분류하였다. 각각의그룹에대해서는환자의나이, 불임의기간, 이전임신과유산의과거력등과난관수종이일측인지또는양측인지를조사하였다. 또, 임신을위해자연임신, 자궁내인공수정, 체외수정시술중어떤방법을시도하였는지와각각에다른임신성공여부, 임신에성공하였다면치료후임신까지걸린기간등을비교연구하였다. 통계처리는윈도우 SPSS ver (SPSS Inc., Chicago, IL, USA) 을이용하여군사이의빈도비교는 chi square test, 군사이의연속변수비교는 Kruskal-Wallis Test 방법으로분석하였고, P-value가 0.05 미 Table 1. Patients characteristics of each group Characteristic No treatment (n=27) Salpingoenostomy (n=29) Surgical treatment Salpingectomy (n=9) Age (yr) 34.1 ± ± ± 1.2 NS Duration of infertility (mo) 34.4 ± ± ± 21.6 NS Gravity 0.9 ± ± ± 0.3 NS Parity 0.2 ± ± ± 0.1 NS No. of spontaneous abortion 0.8 ± ± ± 0.2 NS Basal E ± ± ± NS Basal FSH ± ± ± 4.91 NS Basal LH 3.22 ± ± ± 2.07 NS Bilaterality (%) NS Ovulation disorder (%) NS Uterine anomaly (%) NS Uterine myoma (%) NS Endometrial synechia (%) NS Endometriosis (%) NS Duration of follow-up (mo) 49.4 ± ± ± 4.1 NS Values are presented as mean ± standard deviation. E 2, estradiol; FSH, follicle-stimulating hormone; LH, luteinizing hormone; NS, no significant. P-value 930

3 Ju Youn Bae, et al. The effect of hydrosalpinx treatment 만인경우에통계적으로의미가있다고판단하였다. 결과 전체연구집단의평균추적관찰기간은 45.9 개월, 평균나이는 33.1± 0.5 세였고, 평균불임기간은 36.7 ± 5.1 개월이었다. 수술적치료 를받지않은군과난관신개구술을받은군, 난관절제술을받은군으 로나누었을때각각의평균불임기간은 34.4 ± 7.4 개월, 33.8 ± 6.4 개월, 52.8 ± 21.6 개월이었고, 그룹간의통계학적유의한차이는없었다. 이 전임신횟수, 출산횟수, 유산횟수또한그룹간에통계학적유의한차 이가없었다. 평균나이는난관신개구술을받은군이 31.8 ± 0.6 세로수 술하지않은군의 34.1± 0.9 세, 난관절제술을받은군의 34.1±1.2 세 에비해더젊은편이었으나, 통계학적으로유의한차이는보이지않았 다. 수술적치료를받지않은군의 33.3%, 난관신개구술을받은군의 58.6%, 난관절제술을받은군의 44.4% 에서양측난관의난관수종이 발견되었으며, 각군간의통계학적인차이는없었다. 한측난관수종인 경우반대쪽난관은자궁난관조영술검사나복강경검사시시행한난관 Management of hydrosalpinx No treatment (n=27) Salpingoneostomy (n=29) Salpingectomy (n=9) Pregnancy method Natural (n=3) IUI (n=1) IVF (n=23, 40 cycle) Natural (n=7) IUI (n=6) IVF (n=16, 16 cycle) IVF (n=9, 16 cycle) Successful pregnancy Fig. 1. Clinical pregnancy result of each management in infertility patient with hydrosalpinx. IUI, intrauterine insemination; IVF, in vitro fertilization. n=3 n=0 n=8 n=7 n=2 n=7 n=7 색소검사에서개통되어있음을확인하였다. 동반된불임인자로배란장애, 자궁기형, 자궁근종, 자궁내막유착, 자궁내막증등의유무를조사하였으며, 각군간의통계학적인차이는없었다 (Table 1). 의무기록의분석에의하면난관수종의치료의흐름은수술적치료를하지않고자연임신이나자궁내인공수정임신을 1회에서 3회시도하고, 이방법으로임신에실패하면체외수정임신을시도하는경우와난관신개구술을시행하여난관의기능회복을도모한후자연임신이나자궁내인공수정임신을 1회에서 3회시도하고, 이방법으로임신에실패하면체외수정임신을시도한경우, 그리고난관절제술을시행후체외수정임신을시도한경우였다. 이때난관절제술은양쪽난관수종이심한경우시행하였고, 한쪽만난관수종이있고반대쪽난관은난관수종이없더라도유착이나자궁내막증의정도가심하여난관이제대로기능할수없다고판단되는경우에도시행하였다. 난관수종의수술적인치료를받지않은군의임신성공률은 40.7% (11/27), 수술적치료를받은그룹의임신성공률은 60.5% (23/38) 였고, 난관수종의수술적치료를받은환자중, 난관신개구술을받은군과난관절제술을받은군의임신성공률은각각 55.2% (16/29), 77.8% (7/9) 이었다. 수술적치료를받은군과받지않은군의임신성공률은통계학적유의한차이가없었고, 난관신개구술을받은군과난관절제술을받은군사이에서도차이가없었다 (Table 2, Fig. 2). 난관수종이있음에도수술적치료를받지않고자연임신이나자궁내인공수정임신을시도한경우와난관수종을난관신개구술을통해난관의기능회복을도모한뒤자연임신이나자궁내인공수정임신을시도한경우를비교하였을때, 치료를받지않은군의임신율은 75% (3/4), 한쪽난관신개구술을받은군의임신율은 100% (6/6), 양쪽난관신개구술을받은군의임신율은 42.9% (3/7) 였으며각군사이에통계학적으로유의한차이는없었다. 한편, 특별한수술적치료를받지않은군에서체외수정시술을통해임신에성공한경우는 34.8% (8/23) 인반면난관절제술후체외수정시술을통해임신에성공한경우는 77.8% (7/9) 으로, 난관절제술을시행한군에서통계적으로의미있게높은임신율을보였다 (P = 0.035). 또한세환자군의주기당체외수정시술의성적을비교해보면, 수술적치료를받지않은군에서체외수정시술을시도한환자는 23명이었으며, 모두 40주기의체외수정시술을받았고, 이중 8명이임신에성공하여주기당 20% 의성공률을보였다. 난관신개구술을받은환자중 16명의환자가모두 16주기의체외수정시술을받았고이중 7명이임신에성공하여주기당 43.8% 의성공률을보였다. 또, 난관절제술을받 Table 2. Natural or IUI pregnancy rate after salpingoneostomy Pregnancy rate after salpingoneostomy Pregnancy rate 4/13 (30.8) 2/9 (22.2) 1 ectopic pregnancy Cumulative pregnancy rate 4/13 (30.8) 6/13 (46.2) 1 ectopic pregnancy Values are presented as number (%). 3 mo 6 mo 12 mo 24 mo 1/7 (14.3) 1/6 (16.7) 7/13 (53.8) 8/13 (61.5) 931

4 KJOG Vol. 55, No. 12, 2012 은환자 9명은모두 16주기의체외수정시술을받았고, 이중 7명이임신에성공하여역시주기당 43.8% 의성공률을보였다. 난관신개구술이나난관절제술의수술적치료를받은환자전체를살펴보았을때수술적치료를받은환자중체외수정시술을받은환자 25명이모두 32 주기의체외수정시술을받았고, 이중 14명이임신에성공하여 43.8% 의성공률을보였다. 난관신개구술을받은환자군과난관절제술을받은환자군사이에서체외수정시술의성공률은통계학적으로유의한차이가없었으나, 수술적치료를받지않은군과수술적치료를받은군사이의주기당체외수정시술성공률은각각 20% 와 43.8% 로수술적치료를받은군에서통계학적으로유의하게높은체외수정시술성공률을보였다 (P = 0.028). 그리고각군사이의세포질내정자직접주입술시행률은수술적치료를받지않은군, 난관신개구술을받은군, 난관절제술을받은군에서각각 40주기중 20주기 (50%), 16주기중 2주기 (12.5%), 16주기중 3 주기 (18.8%) 로, 수술적치료를받지않은군에서수술적치료를받은군에비해세포질내정자직접주입술의시행률이통계학적으로유의하게높았다 (P = 0.002). 고찰 난관수종은일차로는폐색된난관으로인한난자의포획을방해하고, 또난관수종내에고인난관수종액이수정란의착상과배아의성장에부정적인영향을주어불임을야기한다고여겨진다. 난관수종이있는환자에게서채취한난관수종액을일정농도차이로혼합한배아배양액에서생쥐의포배기배아를배양하여체외착상률을관찰한연구결과에서난관수종액의농도가증가함에따라체외착상률이감소하였다는보고가있음으로보아난관수종을갖는환자에서임신율의감소가난관수종액과관련이있음을추측할수있다 [7]. 난관수종액에는착상을방해하는 interferon-γ, interleukin-6, tumor necrosis factor-α 등의 cytokine 들이존재하며, 이난관수종액이자궁강내로유입되어수정란의발달및착상에영향을미친다고생각되는데 [8-10], 실제로난관수종이있는환자에서체외수정시술시난관수종액으로여겨지는액체가자궁강에고이며, 이액체를흡입제거하여도다시자궁강에고였다는관찰보고가있었다 [11]. 이외에도난관수종을갖는불임환자에서체외수정시술시임신율이감소된다는보고들이발표되었는데 [12,13], 반대로난관수종이체외수정시술임신율과착상율에악영향을미치지않는다는결과도있었다 [14]. 본연구에서는난관절제술을받아서난관수종을제거한환자군에서수술적치료를받지않고난관수종을남겨둔환자군에비해체외수정임신의성공률이높게나타나 (P = 0.035) 난관수종의존재가임신의성공에나쁜영향을미친다고생각된다. 그러므로만약난관수종이불임의원인으로판단된다면수술적제거또는교정을해주는것이임신율의향상을위한방법이될것이다. 난 관수종환자의수술적치료후임신의예후에대해서는많은연구결과가있는데, Strandell 등 [4] 의연구에의하면양측난관수종환자에서난관절제술후체외수정시술의결과가향상되었고, Johnson 등 [15] 의메타분석연구에의하면난관수종이있는모든환자에서난관절제술후체외수정시술의성공률이증가하였다. 그리고체외수정시술뿐만아니라한측난관에만난관수종이있고, 반대쪽난관은정상인환자에서난관수종이있는쪽을수술적치료를하였을경우자연임신율의향상에대한연구결과또한긍정적으로나타났다 [16]. Choe와 Check [17], 그리고 Aboulghar 등 [18] 은한쪽난관수종절제술후자연임신율이증가하였다고보고하였으며, Sagoskin 등 [16] 도한쪽난관수종을절제하거나근위부에서폐쇄 (proximal tubal occlusion) 시켰을경우정상가임력으로의회복이매우효과적이었고, 특히수술후임신성공까지걸리는시간이현저히짧아졌다고보고하였다. 그리고난관절제술을시행한그룹과근위부난관폐쇄술을한그룹모두에서동일하게임신율이증가하였다는연구결과도있다 [19,20]. 이것은본연구에서도마찬가지로, 난관절제술을시행한그룹에서 77.8% 의체외수정시술을통한임신성공률을보임으로써대조군 (34.8%) 보다약 2배이상의높은체외수정시술성공률을보이고있다. 또, 체외수정시술의성공률을주기당으로분석하였을때도수술적치료를받은군이 43.8% 로수술적치료를받지않은군 (20%) 에비해높은체외수정시술성공률을보였다. 일반적으로가임력은연령이증가할수록감소한다고알려져있는데, 환자의연령에따라기저혈중난포자극호르몬 (follicle stimulating hormone) 의농도, 최고혈중 E 2 농도, 임상적임신율, 유산율, 착상률등에유의한영향을미친다고본다 [21]. 미국생식의학회의 2001년도통계조사에의하면남성불임요인이없는불임부부의체외수정시술시임신율, 출산율, 유산율은각각여성나이 35세미만에서 44.7%, 38.9%, 13.0%, 35-37세에서 39.5%, 32.9%, 13.0%, 38-40세에서 32.2%, 24.3%, 24.5%, 40세초과여성에서 19.1%, 11.1%, 41.6% 로나타나연령이증가함에따라임신율과출산율이감소하는경향을보였다 [22]. 본연구에서환자들의평균나이는난관신개구술을받은군이 31.8세로수술하지않은군과난관절제술을받은군 (34.1세 ) 에비해더젊은편이었으나, 통계학적으로유의한차이는보이지않았고 (P = 0.074), 또 E 2, 난포자극호르몬, 황체형성호르몬이각군사이에통계학적으로유의한차이가없었으므로나이에따른가임력에차이가없다고보고임신율향상평가에고려하지않았다. 사실, 난관절제술이나난관신개구술과같은수술적치료는전신마취의부담과침습적인시술로인한출혈등의위험부담이있다. 게다가유착이심한경우는수술자체가어려울수있으며, 어떤연구결과에따르면난관절제술을하는것이오히려난소로의혈류공급을줄이고, 성선자극호르몬에대한난소의반응을감소시킬수있다는우려도있다 [6,23,24]. 따라서난관수종의수술적치료가힘들다고여겨진다면초음파중재하난관수종액흡인술을고려해볼수도있다. 난관수종환자 66명을대상으로한어떤임의추출연구에따르면초음파중재하난관수종액흡인을시행한환자군에서시행하지않은환자군에비해생 932

5 Ju Youn Bae, et al. The effect of hydrosalpinx treatment 화학적임신율이확실히향상되었다는보고가있다 (43.8% vs. 20.6%, P = 0.04). 그러나이연구에서임상적임신율은흡인을시행한그룹에 서증가하긴하였으나 (31.3% vs. 17.6%) 두그룹간에통계학적차이 가없었고 (P = 0.20), 또생화학적임신후의자연유산율도감소하였으 나 (28.6% vs. 42.9%) 두그룹간에통계학적의미는없었다 (P = 0.56) [5]. 하지만난관수종액을흡인해줌으로써난포의성숙및착상에긍 정적인영향을준다는연구결과 [25] 도있어난관수종의수술적치료 가힘들경우단순히체외수정시술만하는것보다초음파중재하난관 수종액흡인술을함께시도해보는것도임신율의향상에도움이될것 으로생각되며, 이에대해서는좀더연구가필요할것이다. 본연구는후향적으로진행되어난관수종진단이나수술당시에난 관수종의정도, 난관채의기능보존정도, 복강내유착정도등은파악 할수가없었다. 난관수종이심하지않고, 복강내유착이적고, 난관채 의기능이보존되어있을수록난관신개구술이후에난관이제기능을 할수있을것으로추측되는바 [26], 난관수종의중등도에대한자료도 함께수집하여난관신개구술후가임능력회복과의상관관계를알아 본다면더욱충실한연구가되었으리라생각한다. 또, 여러명의의사 들이수술하였고, 각각의수술방법이동일하지않으므로그에따른예 후의차이도변수로작용할수있겠지만본연구에서는고려하지않았 다. 또한, 본원의특성상타병원에서의뢰되어본원으로와난관수종 을진단및수술적치료를받은후다시연고지로돌아가추적관찰에 실패한환자들이약 38% 에달하는데, 이것은결과적으로연구대상환 자수가줄어들게한한계점이있다. 하지만본연구결과를토대로향후 전향적연구를시행하여이런한계를극복한연구를시행하고자한다. References 1. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod 1999;14: Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril 1998;70: Koong MK, Song IO. The effect of hydrosalpinx and its surgical correctionon pregnancy rate and implantation rate following in vitro fertilizationand embryo transfer. Korean J Obstet Gynecol 1997;40: Strandell A, Lindhard A, Waldenstrom U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod 1999;14: Hammadieh N, Coomarasamy A, Ola B, Papaioannou S, Afnan M, Sharif K. Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial. Hum Reprod 2008;23: Lass A, Ellenbogen A, Croucher C, Trew G, Margara R, Becattini C, et al. Effect of salpingectomy on ovarian response to superovulation in an in vitro fertilization-embryo transfer program. Fertil Steril 1998;70: Jun JH, Koong MK, Lim CK, Kim SK, Kang IS. Effect of hydrosalpingeal fluid on the implantation in-vitro in a murine model. Korean J Fertil Steril 2000;27: Haimovici F, Hill JA, Anderson DJ. The effects of soluble products of activated lymphocytes and macrophages on blastocyst implantation events in vitro. Biol Reprod 1991;44: Jacobs AL, Sehgal PB, Julian J, Carson DD. Secretion and hormonal regulation of interleukin-6 production by mouse uterine stromal and polarized epithelial cells cultured in vitro. Endocrinology 1992;131: Wuu YD, Pampfer S, Becquet P, Vanderheyden I, Lee KH, De Hertogh R. Tumor necrosis factor alpha decreases the viability of mouse blastocysts in vitro and in vivo. Biol Reprod 1999;60: Mansour RT, Aboulghar MA, Serour GI, Riad R. Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation. J In Vitro Fert Embryo Transf 1991;8: Andersen AN, Yue Z, Meng FJ, Petersen K. Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography. Hum Reprod 1994;9: Vandromme J, Chasse E, Lejeune B, Van Rysselberge M, Delvigne A, Leroy F. Hydrosalpinges in in-vitro fertilization: an unfavourable prognostic feature. Hum Reprod 1995;10: Sharara FI, Scott RT Jr, Marut EL, Queenan JT Jr. In-vitro fertilization outcome in women with hydrosalpinx. Hum Reprod 1996;11: Johnson NP, Mak W, Sowter MC. Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review. Hum Reprod 2002;17: Sagoskin AW, Lessey BA, Mottla GL, Richter KS, Chetkowski RJ, Chang AS, et al. Salpingectomy or proximal tubal occlusion of unilateral hydrosalpinx increases the potential for spontaneous pregnancy. Hum Reprod 2003;18: Choe J, Check JH. Salpingectomy for unilateral hydrosalpinx may improve in vivo fecundity. Gynecol Obstet Invest 1999;48: Aboulghar MA, Mansour RT, Serour GI. Spontaneous intrauterine pregnancy following salpingectomy for a unilateral 933

6 KJOG Vol. 55, No. 12, 2012 hydrosalpinx. Hum Reprod 2002;17: Murray DL, Sagoskin AW, Widra EA, Levy MJ. The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rates and the benefit of surgical correction. Fertil Steril 1998;69: Surrey ES, Schoolcraft WB. Laparoscopic management of hydrosalpinges before in vitro fertilization-embryo transfer: salpingectomy versus proximal tubal occlusion. Fertil Steril 2001;75: Moon SY, Suh CS, Lee JS, Kim SH, Choi YM, Shin CJ, et al. The outcome of IVF-ET according to age. Korean J Fertil Steril 1995;22: Society for Assisted Reproductive Technology; American Society for Reproductive Medicine. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry. Fertil Steril 2007;87: Dechaud H, Hedon B. What effect does hydrosalpinx have on assisted reproduction? The role of salpingectomy remains controversial. Hum Reprod 2000;15: Gelbaya TA, Nardo LG, Fitzgerald CT, Horne G, Brison DR, Lieberman BA. Ovarian response to gonadotropins after laparoscopic salpingectomy or the division of fallopian tubes for hydrosalpinges. Fertil Steril 2006;85: Aboulghar MA, Mansour RT, Serour GI, Sattar MA, Awad MM, Amin Y. Transvaginal ultrasonic needle guided aspiration of pelvic inflammatory cystic masses before ovulation induction for in vitro fertilization. Fertil Steril 1990;53: Milingos SD, Kallipolitis GK, Loutradis DC, Liapi AG, Hassan EA, Mavrommatis CG, et al. Laparoscopic treatment of hydrosalpinx: factors affecting pregnancy rate. J Am Assoc Gynecol Laparosc 2000;7: 불임환자에서난관수종의수술적치료가임신의예후에미치는영향 관동대학교의과대학제일병원산부인과배주연, 구화선, 황유임, 박찬우, 차선화, 양광문 목적저자들은불임환자에서의난관수종의수술적인치료가임신의성공에미치는영향에대해연구해보고자하였다. 연구방법 2006년부터 2009년까지본원에서자궁난관조영술검사로난관수종을진단받은불임환자 106명중추적관찰이가능한 65명을대상으로의무기록을후향적으로분석하였다. 난관수종의수술적인치료를받지않은군 (n=27) 과수술적인치료를받은군 (n=38) 으로나누었고, 후자를수술의방법즉, 난관신개구술을받은그룹 (n=29) 과난관절제술을받은그룹 (n=9) 으로분류하여임신과관련된여러요인을비교분석하였다. 결과나이, 불임기간, 임신력, 동반불임요인분석에서각군간의통계학적인차이는없었다. 특별한수술적치료를시행하지않은군에서체외수정시술을통해임신성공한경우는 34.8% (8/23) 인반면난관절제술후체외수정시술을통해임신에성공한경우는 77.8% (7/9) 의결과를보여난관절제술을시행한군에서통계적으로의미있게높은임신율을보였다 (P = 0.035). 체외수정시술을주기당분석한결과에서도수술적치료를받은군이받지않은군에비해높은체외수정시술성공률을보였다 (P = 0.028). 결론 난관수종의수술적치료는체외수정시술을통한임신의성공에도움이될것으로생각된다. 중심단어 : 난관수종, 난관절제술, 난관신개구술, 임신율, 체외수정시술 934

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar