질식자궁적출술시 질을 통한 난관난소절제술의 위험도는 없거나 혹은 사소한 것으로 생각되며, 가장 위험한 합병증인 요관의 손상의 경우 또한 요관과 누두골반 혈관과의 거리가 중요한 요인이지만 요관의 손상은 없는 것으로 나타났다. 자궁부속기 처치가 총 수술 시간에 미치는 영향 또한 미미한 것으로 생각된다. 본원의 증례에서는 질식자궁적출술 이후에 자궁 부속기에 출혈이 있거나, 육안상 병변이 있는 경우 난관난소절제술 시행하는 경우가 대부분이었으나, 폐경기 후 환자에게서 질식자궁적출술 이후 선택적 난소절제술을 시행할 때나, 질식자궁적출술의 적응 증이 됨에도 불구하고 자궁부속기에 병변이 동반되 어 있거나, 또 질식자궁적출술중에 자궁부속기의 출 혈 혹은 자궁부속기의 병변 발견된 경우에도 개복술 로 전환할 필요 없이 수술자가 질식 수술에 많은 훈 련과 경험이 있고 수술 보조자의 능숙한 도움이 있 다면 질식자궁부속기절제술을 안전하게 시행할 수 있을 것이라 사료되며, 향후 부인과 의사들은 자궁 부속기에 유착이 없고 유동성이 있으며 접근성이 좋 은 경우부터 질식자궁적출술 관한 술기와 경험을 습 득 후 질식자궁부속기절제술이 가능할 것으로 사료 된다.

Objective: The purpose of this study is evaluation of the method, complications, operation time, and operability of vaginal removal of the adnexae after vaginal hysterectomy. Study design: This study was attempted to analyze 105 women underwent vaginal removal of the adnexae in association with vaginal hysterectomy at Department of Obstetrics and Gynecology, School of Medicine, Hallym University, Kangnam Sacred Heart Hospital, from Jan. 1991 to Dec. 1995. Results: Both salpingoophorectomy was performed in 5 patients, unilateral salpingo-ophorectomy (92: left-42, right-50), oophorectomy without salpingectomy (7) were done. And eighty four patients underwent posterior vaginal repair, twenty-one patient underwent anterior-posterior vaginal repair. Most common indications of adnexectomies were macroscopic lesions of the ovaries (cysts, inflammatory change, etc.), and other indications were elective oophorectomy (18), bleeding pedicle (3). Pathologic findings of the ovaries were normal (18), benign cystic tumor (69), benign solid cyst (14), endometriosis, inflammatory change, etc (4). The complications were fever (12), urinary tract infection (1), vaginal stump infection (2), postoperative transfusion (7), re-laparotomy (2). Most complications were associated with vaginal hysterectomy. But there was no evidence that a ureter injury that was major complication of vaginal adnexectomy, was in any of the patients. The average time for vaginal hysterectomy with bilateral salpingoophorectomy was 96 minutes and unilateral salpingoophorectomy was 94 minutes including anterior or posterior and combined vaginal repair time. The average hospitalization was 7∼8 days. Conclusion: There appears to be little or no risk involved in removing the adnexae through the vagina during vaginal hysterectomy. However, vaginal adnexectomy requires special skill and judgment and should be performed only by gynecologists who are trained and experienced in vaginal surgery.