난치의 자궁출혈을 위한 내장골동맥 결찰의 2례

오성규(SK Oh),곽현모(HM Kwak),이연희(YH Lee),이용배(YB Lee),양영호(YH Yang) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.9

Hemoorrhage is still one of the most important cause of maternal mortality and also in Gyn- ecological field, we meet occasionally profuse hemorrhage which is difficult or impossible to control by the conventional methods of packing or suturing, or both. In such situation that multiple transfusion, plasma and packing with suturing failed to control bleeding, we must decide some definite procedure before patient drops in shock and in death. This report deals with our experiences on several cases of Internal Iliac ligation permanently or temporally and reported two cases, one case is trophoblastic tumor possibly degenerate chorircarcinoma of the uterus and the other is abvanced carcinoma of the cervix. In both cases, we got excellent result and bleeding stopped immediately and could save them. We reviewed several articles concerning ligations of the Internal Iliac Artery and summarize anatomical relationship about surgical anatomic character of vesseles involved. There is enough and adequate collateral circulation in the pelvic organs and even after both bilateral Internal Oliac artery and ovarian artery ligation, there is no artery evidence of ill effects upon the pelvic viseera including the bladder and the bowel. Interesting study about the hemodynamics of ligation of Internal Oliac artery by Dr. Clay Burchell reported only unilateral ligation decreased pulse pressure significantlu and show adequate result. In the past time ligation of the Internal Iliac artery was performed in the case of Gynecological malignancy such as cervical cancer and uterine cancer but recentlu it is used in non-malignant cases such as postpartumhemorrhage or vault bleeding after hysterectomy ect. All Obstetrician, Gynecologist and do this operation for the patient who need it without delay or waiting, because it may cost the patient her life.

임신부사망및 페리네탈사망에 관한 임상적 고찰

문영기(YK Moon),오성규(SK Oh),이재억(JA Lee),양인환(IW Yang) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.9

14 cases of maternal deaths were encountered among 2864 deliveries and 151 prenatal cases. Average maternal mortality was 50.5. There were 80 cases of stillbirths and 92 cases of neonatal deaths among the 2914 births. Average perinatal mortality was 62.1. These were seen at Yonsei University Hospital between February, 1959 and August 1964. Rate of maternal mortality decreased rapidly in comparison to perinatal mortality. The majority of preinatal deaths were in the premature group. Prenatal care controlled the maternal mortality and perinatal mortality. All of the maternal deaths had not been under prenatal care. Maternal mortality committee and perinatal mortality committee are needed for control maternal mortality and perinatal mortality.

자궁내구기능부전증 - 임신중 외과적 치료에 대하여

문영기(YK Moon),오성규(SK Oh),이준환(JH Lee),홍성선(SS Hong) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.9

The Shirodkar operation were performed on 19 cases with incompetent internal os of the cervix in pregnancy. These cases were seen at Yonsei University Hospital between February, 1959 and August, 1964. However the following 2 cases showed abnormal tissue reactions around the cervix which disturbed the normal courses of labor. Vaginal deliveries following Shirodkar operation were 80% successful. Corrected data showed 93.3% Shirodkar operation and trachelorrhaphy are needed in cases of incompetent internal os with deep cervical laceration.

임신에 합병된 자궁경암에 관한 임상적 고찰

김준걸(JK Kim),박찬규(CK Park),전종수(JS Chun),오성규(SK Oh) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.9

The recent emphasis upon the early diagnosis of malignant neoplasms has been more rewarding in the case of carcinoma of the cervix than perhaps with any other cancer, because of the widespread publicity given this lesion, and due to the increasing awareness of the value of the Papanicolaou smear in the diagnosis of the earliest stages of the disease. Theoretically, carcinoma of the cervix might be completely eradicated by mass screening methods, routine Papanicolaou smears, and regular pelvic examination beginning at an early age. From the practical viewpoint, however, this yet difficult in Korea for reasons of economy and because of the reticence of a large segment of our population to visit physicians unless something is wrong. Failure to examine pregnant patients completely and to take smears during pregnancy has been based upon the reasoning that smears are of no value during pregnancy, and that biopsy during pregnancy may precipitate abortion, bleeding, infection, and dystocia due to cervical stricture. Recently, it has come to be known that there is no contraication for cervical biopsy during pregnancy when necessary; further pathologists are now generally in accord with the fact that smears are accurate during pregnancy, and that changes in the vaginal and cervical cells during pregnancy are easily distinguishable from those brought about by malignant change. According to the literature, cervical cancer associated with pregnancy is relatively rale. But we have seen 19 cases in situ and invasive cervical cncer between Feb. 1959 and Aug. 1964 and clinically analized them, and reviewed literatures. Carcinoma of cervix in the first trimester of pregnancy, particulary in the situ stages, is undoubtedly present much more frequently than has previoosly been suspected. Roution smear examination at the First prenatal visit will aid tremendously in discovering these lesions before invasion begins. In general, treatment of the cervix in the first trimester follows the same treatment methods employed in nonpregnant patient. Cone biopsy and punch biopsy essential to rule out not only malignant changes but also invasive cancer those patients whose smears have been reportedas suspicious and who have suspicious local lesions. When associated invasive cancer continuation of pregnancy should not be considered, however, if lesion is proved by cone to be in-situ, the pergnancy may continue in normal fashion. In 2nd or 3rd trimester, obstetrics is the only branch of medicine in which two lives have to be considered directly in making therapeutic decisions. It is sometimes necessary, albeit distressing, to have to favor one of the two. Selection of the best therapy in carcinoma of the cervix associated with pregnasncy is most difficult in 2nd and 3rd trimester because of the need to give optimal chances to both the maternal and fetal lives. Those who have struggled with this problem generally agree that before the third trimester the carcinoma should be treated promptly and fully without regard to the fetus and that, for some reason, the maternal prognosis for carcinoma of the cervix worsens materially in 2nd and 3rd trimester. So that 1) The pregnancy should be terminated by classic sesarean section or hysterotomy as so onas the diagnosis is made, except in rare situations such as primigravidity or strong religious considerations. Three reasons support this apprort this approach First, full and immediate therapy can be applied and is in the best maternal interest. 2nd can occasionally result in a premature infant who survive and be normal. 3rd average parity of the auther`s patients and those reported in the literature is 3 to 5. 2) After evacuation of the uterus, conventional radiation therapy should be employ for all patients with favourable or unfavourable stage. Or radical hysterectomy with dissection of lymph nodes for fatients of operable carcinoma of the cervix.