목적: 양성종양의 불필요한 개복수술과 악성종양의 부적절한 골반경수술을 피하고 자궁부속기종양 골반경수술의 비율을 높이기 위함 연구방법: 정해진 개복수술의 지침에 따라 자궁부속기 종괴의 개복 또는 골반경수술을 시행하고 수술방법, 수술시간, 재원기간, 합병증, 개복수술 요인과 개복수술의 적합성 여부에 대한 수술자 의견 등이 분석됨. 결과: 18개월간 자궁부속기 종괴로 개복수술[159명]과 골반경수술[129명]이 시행됨. 개복수술/골반경수술 비율은 전체적으로 55.2%/44.8%, 비종양성 종괴는 44.5%/55.5%, 양성종양은 58.1%/41.9%, 경계성종양 100.0%/0.0%, 악성종양 91.7%/8.3%임. 주요 개복이유로 비종양성 자궁부속기 종괴는 복막염 또는 혈복강을 의심하는 증상 징후와 함게 불안정한 생체활력징후[32.1%]와 중증 골반강내 유착의 강력한 의심이나 확인[24.5%], 양성종양은 세밀한 낭종박피술이 필요한 직경 6cm 이상의 종괴[26.7%]와 중증 골반강내 유착의 강력한 의심이나 확인 [18.6%]임. 난소암 골반경수술은 1례[0.78%]임. 수술자는 개복수술의 28.9%가 골반경수술에 적합했을 것으로 판단함. 결론: 자궁부속기 종양에 있어 골반경수술이 개복수술보다 더 나은 방법이며 유착을 의심하는 환자나 의심스런 종괴에 대해서도 신중한 골반경수술의 재고가 필요하리라 사료됨. 또 한편 골반경수술 적용을 위해 더 주의깊은 수술 전, 수술 중 검사가 이뤄져야 할 것임.

Objective: To increase proportion of pelviscopic surgery, and besides, avoid unnecessary laparotomy for benignity and pelviscopic surgery of malignancy in adnexal masses. Methods: Adnexal masses were managed by laparotomy or laparoscopy under the stated guideline. We analyzed data of the surgical procedure, operative time, hospital stay, and complication, guideline applied and the operator`s opinion on the adequacy of each laparotomy. Results: Over an 18-month period, laparotomy [n=159] or pelviscopy [n=129] were performed. Mean operative time and hospital stay in the pelviscopy group were shorter than those in the laparotomy group. The proportion of laparotomy/pelviscopy were 55.2%/44.8% in overall, 44.5%/55.5% in non-neoplastic tumors, 58.1%/41.9% in benign neoplasm, 100.0%/0.0% in borderline tumor and 91.7%/8.3% in malignancy. The main reasons of laparotomies were unstable vital sign with some symptoms and signs of generalized peritonitis or hemoperitoneum[32.1%] and suspected severe pelvic or abdominal adhesion [24.5%] in non-neoplastic tumor. The patients of benign neoplasms had laparotomies chiefly due to elaborate enucleation in the cyst of diameter 6cm for fertility[26.7%] and suspected severe pelvic or abdominal adhesion [18.6%]. Pelviscopic surgery of ovarian cancer was 1 case [0.78%]. Operator was of opinion that the rate of inadequacy in laparotomies was 28.9% in overall. Conclusion: Pelviscopic surgery is superior to laparotomy in the management of adnexal masses and may be considered prudently in patients of pelvic adhesion suspected and in adnexal tumors those can`t confirm as benignancy. In addition to preoperative evaluations, operative findigs and frozen biopsy should be obtained more carefully for pelviscopy of adnexal tumors.