• Radiation Oncology Journal
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• 제14권3호
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• pp.211-219
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• 1996

목적 : 상피내암, 초기 침윤성 자궁경부암, 또는 양성 질환으로 자궁적출술 받은 후 침윤성 자궁경부암으로 확인되어 방사선치료를 받은 환자의 치료 결과와 예후를 분석 하고자 하였다. 대상 및 방법 : 1985년 9월부터 1993년 12월까지 수술후 침윤성 자궁암으로 진단되어 방사선치료를 시행한 61명의 환자를 대상으로 후향적 분석을 시행하였다. 수술전 진단은 상피내암이 가장 많았으며 (38명), 초기 침윤성 자궁암 (10명), 자궁근종 (6명)등이었다. 대부분 수술후 2개월 이내에 방사선치료를 시행하였으며 3명은 추적검사중 재발암으로 확인되어 치료하였다. 8명은 강내치료만을, 47명은 외부 방사선치료만을, 그리고 6명은 강내치료와 외부 방사선치료를 같이 시행하였다. 결과 : 5년 생존율 및 무병 생존율은 각각 $83.8\%$, $86.9\%$ 였으며 수술 당시의 육안적 잔존병소가 있었던 경우는 $38.4\%$로 매우 낮았다. 모두 8명의 치료실패가 있었으며 예후인자로는 후향적 병기, 잔존병소 유무, 병리조직유형이 있었다. 결론 : 조기 침윤성 자궁암은 부적절한 수술후에도 방사선치료로 효과가 좋으나 잔존병소가 있는 경우에는 예후가 불량하므로 좀 더 적극적인 치료가 필요하며, 무엇보다도 조기에 정확한 검진과 병기 결정을 시행하여 각 병기에 따른 적절한 치료가 필요하다.

• Journal of Preventive Medicine and Public Health
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• 제43권3호
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• pp.235-244
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• 2010

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

• 한국의료질향상학회지
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• 제18권1호
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• pp.71-78
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• 2012

Background : The objective of this study was to examine the effect of management system for the appropriate prophylactic use of antibiotics in surgical patients at a tertiary hospital from 2007 to 2010. Methods : We collected clinical data of three different surgical procedures(colectomy, heart surgery, hysterectomy) for three months of 2007 and 2010, respectively. The number of total cases was 245(137, 54, 54) in 2007, 240(133, 42, 65) in 2010. We measured the rate of use of inappropriate prophylactic antibiotics, administration within 1 hour prior to the incision and the antibiotics prescription days after surgery. To evaluate the effectiveness of the management system, the results of the two groups(Group1=2007, Group2=2010) were compared by t-test, chi-square test or Fisher's exact test. Result : The rate of Aminoglycoside uses decreased drastically from 11.4% to 0.8%(P<.001). The selection of 3rd/4th Cephalosporin dropped from 11.8% to 5.8%(P=.020). The combination of antibiotics decreased from 27.8% to 11.7%(P<.001). The antibiotic prescription rate on discharge declined from 11.8% to 2.5%(P<.001) and the number of antibiotics prescription days after surgery was shortened from 4.2 days to 2.3 days(P<.001). No significant difference in the rate of administration within 1 hour between two groups was found. Through 3-year management, 5 out of 6 measures were significantly improved(except the administration within 1 hour). The rate of surgical site infection decreased from 2.4% to 1.3%(P=.504). Conclusion : The findings demonstrate that the management system for the prophylactic use of antibiotics in surgical patients was effective in decreasing the rate of surgical site infection during 3 years.