학술논문
여호와 증인 환자에서 산부인과적 무혈 수술의 임상적 고찰
Obstetric and Gynecologic Bloodless Surgery in Jehovah`s Witnesses
Obstetric and Gynecologic Bloodless Surgery in Jehovah`s Witnesses
Document Type
Article
Author
Source
Obstetrics & Gynecology Science. May 30, 2000 43(5):858
Subject
Language
Korean
ISSN
2287-8572
Abstract
목적 : 여호와의 증인은 자신들의 교리에 따라 혈액이나 기타 혈액제재의 사용을 거부하는 종파이다. 이들에 대한 산부인과적 무혈 수술의 임상상 및 술 후 결과를 후향적으로 검토하였다. 연구방법 : 1995년 2월부터 1999년 8월까지 세종병원에서 입원 기간 중 어떠한 혈액이나 혈액제재를 투여 받지 않았던 여호와의 증인 환자 50예에 대해 무혈 수술의 성적을 후향적으로 조사하였다. 결과 : 환자의 연령 분포는 9세와 58세 사이로 평균 36.7 ± 8.7세 이었다. 무혈 수술의 가장 흔한 사례는 제왕 절개술이었다. 인간 조혈촉진인자(EPO)를 제왕 절개술 5예, 전자궁 적출술 2예, 난소 종양 2예에 투여하였다. EPO를 투여 받은 9예에서는 평균 혈색소 수치가 수술 전에 비해 수술 후 오히려 의미있게 증가하였다. 조직학적 결과로는 자궁 선근증 9예, 평활근종 8예, 생식 세포종 3예, 자궁외 임신 2예, 자궁 상피내 종양 1예, 상피성 난소 종양 1예, 출혈성 황체 낭종 1예, 성기삭 간질성 종양 1예로 총 27예이었다. 무혈 수술로 인한 술 후 사망은 없었으며 이환율도 적었다. 결론 : 여호와의 증인 환자에 대한 산부인과적 수술이 요구될 때 세심한 수술 기법과 다양한 혈액 보존법 등을 이용한다면 비교적 양호한 무혈 수술의 결과를 얻을 수 있었다. 그러나 향후 여호와의 증인 환자에 대한 특수화된 프로그램의 개발이 필요하다고 사료되었다.
Objective : Jehovah's Witnesses are members of a religious denomination whose beliefs prohibit the use of blood or blood products. Plasma volume expanders and extracorporeal hemodilution of the patients's own blood are theologically acceptiable. And so we evaluated effectiveness of major operative procedures carried out on Jehovas's Witnesses patients without blood transfusions or blood products. Methods : We retrospectively studied 50 cases of Jehovas's Witnesses who underwent obstetric and gynecologic bloodless surgery from February 1995 to August 1999. No patients recieved any blood or blood products during hospitalizaion. Results : The age distribution of patients was between 9 years and 58 year, average 36.7±8.7 years old. The most common cases for bloodless surgery was Cesarean section. The recombinant human erythropoietin(EPO) was treated in 5 cases of Cesarean section, 2 cases of TAH and 2 cases of ovarian tumor perioperatively. EPO-treated 9 cases were increased postoperative mean Hb levels compared with preoperative mean Hb levels. Histology revealed 9 cases of adenomyosis, 8 cases of leiomyoma, 3 cases of germ cell tumor, 2 cases of ectopic pregnancy, 1 case of CIS, 1 case of Krukenberg tumor, 1 case of epithelial cell tumor, 1 case of hemorrhagic corpus tumor and 1 case of sexcord stromal tumor, total 27 cases. There was no operative death and postoperative morbidities were few. Conclusions : We concluded that if we preformed the surgeries with careful operative techniques and various blood conserving procedures we could do the bloodless surgery of Jehovah's Witnesses with relative safety. But the establishment of a well programmed special medical supports for the Jehovah's Witnesses community will be needed in future.
Objective : Jehovah's Witnesses are members of a religious denomination whose beliefs prohibit the use of blood or blood products. Plasma volume expanders and extracorporeal hemodilution of the patients's own blood are theologically acceptiable. And so we evaluated effectiveness of major operative procedures carried out on Jehovas's Witnesses patients without blood transfusions or blood products. Methods : We retrospectively studied 50 cases of Jehovas's Witnesses who underwent obstetric and gynecologic bloodless surgery from February 1995 to August 1999. No patients recieved any blood or blood products during hospitalizaion. Results : The age distribution of patients was between 9 years and 58 year, average 36.7±8.7 years old. The most common cases for bloodless surgery was Cesarean section. The recombinant human erythropoietin(EPO) was treated in 5 cases of Cesarean section, 2 cases of TAH and 2 cases of ovarian tumor perioperatively. EPO-treated 9 cases were increased postoperative mean Hb levels compared with preoperative mean Hb levels. Histology revealed 9 cases of adenomyosis, 8 cases of leiomyoma, 3 cases of germ cell tumor, 2 cases of ectopic pregnancy, 1 case of CIS, 1 case of Krukenberg tumor, 1 case of epithelial cell tumor, 1 case of hemorrhagic corpus tumor and 1 case of sexcord stromal tumor, total 27 cases. There was no operative death and postoperative morbidities were few. Conclusions : We concluded that if we preformed the surgeries with careful operative techniques and various blood conserving procedures we could do the bloodless surgery of Jehovah's Witnesses with relative safety. But the establishment of a well programmed special medical supports for the Jehovah's Witnesses community will be needed in future.