難治의 子宮出血을 爲한 內腸骨動脈 結紮의 2例 : Hypogastric = Ligation of the Internal Iliac Artery

다국어 초록 (Multilingual Abstract)

Hemorrhage is still one of the most important cause of maternal mortality and also in Gynecological 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 drop 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 degenerated choriocarcinoma of the uterus and other is advanced carcinoma of the cervix. In both cases, we get 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 bilateralInt ernal Iliac artery and ovarian artery ligation, there is no artery evidene of ill effects upon the pelvic viscera including the bladder and the bowel.
Interesting study ,about the hemodynamics of ligation of Internal Iliac artery by Dr. Clay Burchell reported only unilateral ligation decreased pulse pressure significantly and show adeguate result.
In the past time ligation of the Internal Iliac artery was performed in the case of Gyncological maligneancy such as cervical cancer and uterine cancer but recently it is used in non-malignant cases such as postpartum hemorrhage or vault bleeding after hysterectomy etc. All Obstetrician, Gynecologist and general Surgeon who do pelvic operation should familiar with this life-saving procedure and do this operation for patient who need it without delay or waiting, because it may cost the patient her life.