한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제28권6호
  • /
  • Pages.566-570
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  • 2011
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  • 1598-298X(pISSN)
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  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
권호 표지

개의 난소자궁적출술에 있어서 티타늄클립의 두 가지 적용방법에 대한 비교

Comparison of Two Techniques on Titanium Clip Application for Ovariohysterectomy in Bitches

  • Park, Jin-Seok (Department of Veterinary Obstetrics and Theriogenology, College of Veterinary Medicine, Chungbuk National University) ;
  • Kang, Hyun-Gu (Department of Veterinary Obstetrics and Theriogenology, College of Veterinary Medicine, Chungbuk National University) ;
  • Kim, Ill-Hwa (Department of Veterinary Obstetrics and Theriogenology, College of Veterinary Medicine, Chungbuk National University)
  • 심사 : 2011.12.14
  • 발행 : 2011.12.31
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초록

본 연구에서는 난소자궁적출술에 있어서 티타늄(titanium) 클립 적용 시 발생할 수 있는 합병증을 평가하고, 난소혈관과 난소걸이인대의 두 가지 결찰법을 비교하여 합병증을 최소화 할 수 있는 수술법을 찾고자 하였다. 실험을 위해 6마리의 암컷 비글견이 사용되었으며, 세 마리씩 두 그룹으로 나누어 한 그룹은 난소걸이인대와 난소혈관을 함께 결찰 하였고, 나머지 한 그룹은 난소걸이인대를 결찰하지 않고 난소혈관만 결찰 하였다. 두 수술법을 비교하기 위해서 매달 1회씩 1년 동안 복강 X-ray 검사를 통해 적용된 클립의 위치 변화를 확인하였고, 적용된 클립에 의한 염증반응 유무는 혈액검사를 통해 확인하였다. X-ray 검사 상에서 두 그룹의 클립 위치는 큰 변화를 보이지 않았으며, 혈액 검사에서도 거의 모든 수치들이 정상범위에 있었고, 염증과 관련된 임상증상 또한 관찰되지 않았다. 부검을 통한 두 그룹의 클립 포매 형태를 관찰한 결과 난소걸이인대를 결찰한 클립은 복강의 얇은 막으로 두껍게 싸여서 신장 후연에 위치하고 있는 것을 확인하였고, 난소걸이인대를 결찰하지 않은 클립은 얇게 둘러싸인 막 표면에 위치하여 신장의 아래쪽에서 관찰되었다. 이러한 결과는 난소걸이인대가 클립의 움직임을 최소화 할 수 있도록 지지해주는 역할을 하는 것을 의미하며, 따라서 티타늄 클립을 적용하는 난소자궁적출술에서 난소걸이인대를 함께 결찰하는 방법이 합병증 예방에 있어서 보다 적합한 방법으로 생각된다.

The objective of this study was to assess the complications of titanium clip application after ovariohysterectomy (OHE) and find the proper surgical technique to minimize the complications by comparing the ligation method of ovarian pedicle. Six female beagle dogs were used for this study and they were divided randomly into two groups by ligation techniques: ligation and non-ligation of the suspensory ligament of ovary including ovarian pedicle. To evaluate the difference between two techniques, the location and embedded pattern of applied clips in the abdominal cavity were identified through radiographic tests and autopsy. Hematology tests were also performed to check the existence of inflammation by applied clips and all tests were carried out monthly for 1 year. There were few changes in location of clips of both groups on X-ray views without any migration. Almost all values in hematology of two groups were within the normal range and there were no inflammatory symptoms. All of applied clips in two groups were found near the kidney, but the embedded forms of them showed slight differences. The clips ligating suspensory ligament and ovarian pedicle were located in deep place and thickly surrounded with thin layers of peritoneum. But the clips ligating only ovarian pedicle were found with ease on surface of layer and located in lower place compared with the clips ligating suspensory ligament. These results indicate that the suspensory ligament holds applied clips and minimizes the movement of them. Therefore, ligation of suspensory ligament would be the preferred technique in titanium clip application for OHE.

키워드

참고문헌

  1. Bencharif D, Amirat L, Garand A, Tainturier D. Ovariohysterectomy in the bitch. Obstet Gynecol Int 2010; 2010: 542693.
  2. Gupta AN, Chakravarti RN, Majumdar S, Mapa MK, Dhall GI. Pathological changes in fallopian tubes following three different kinds of occlusive techniques in primates. Contraception 1986; 33: 245-255. https://doi.org/10.1016/0010-7824(86)90017-X
  3. Hasan A, Evgenikos N, Daniel T, Gatongi D. Filshie clip migration with recurrent perianal sepsis and low fistula in ano formation. BJOG 2005; 112: 1581. https://doi.org/10.1111/j.1471-0528.2005.00744.x
  4. Fossum TW, Hedlund CS, Johnson AL, Schulz KS, Seim HB, Willard MD, Bahr A, Carroll GL. Surgery of the reproductive and genital systems. In: Small animal surgery, 3rd ed. St. Louis: Mosby Elsevier. 2007: 702-714.
  5. Howe LM. Surgical methods of contraception and sterilization. Theriogenology 2006; 66: 500-509. https://doi.org/10.1016/j.theriogenology.2006.04.005
  6. International Organization for Standardization Technical Committee: International Standard ISO 5832-3: Implants for Surgery-Metallic Materials-Part 3: Wrought Titanium 6-Aluminium 4-Vanadium Alloy. Geneva: International Organization for Standardization. 1996.
  7. Kesby GJ, Korda AR. Migration of Filshie clip into the urinary bladder seven years after laparoscopic sterilization. Br J Obstet Gynaecol 1997; 104: 379-382. https://doi.org/10.1111/j.1471-0528.1997.tb11473.x
  8. Konate A, Rauzy V, Chalon S, Ceballos P, Riviere S, Ciurana AJ, Le Quellec A. Intraperitoneal migration of Filshie tubal sterilization clips: an uncommon cause of chronic abdominal pain. Gastroenterol Clin Biol 2002; 26: 630-632.
  9. Lawton MT, Ho JC, Bichard WD, Coons SW, Zabramski JM, Spetzler RF. Titanium aneurysm clips: Part 1-mechanical, radiological, and biocompatibility testing. Neurosurgery 1996; 38: 1158-1164.
  10. Mayhew PD, Brown DC. Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-associated ovariohysterectomy. Vet Surg 2007; 36: 541-547. https://doi.org/10.1111/j.1532-950X.2007.00280.x
  11. Pandit M. Early extrusion of bilateral Filshie clips after laparoscopic sterilisation. BJOG 2005; 112: 680. https://doi.org/10.1111/j.1471-0528.2004.00515.x
  12. Penfield AJ. The Filshie clip for female sterilization: a review of world experience. Am J Obstet Gynecol 2000; 182: 485-489. https://doi.org/10.1067/mob.2000.104620
  13. Tan BL, Chong C, Tay EH. Migrating Filshie clip. Aust N Z J Obstet Gynaecol 2004; 44: 583-584. https://doi.org/10.1111/j.1479-828X.2004.00295.x