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Brunschwig氏 骨盤臟器 全剔除術 術式에 對하여

대한산부인과학회지 1958년 1권 2호 p.16 ~ 20
유흥진 (  ) - 성신대학의학부

Abstract


The recent resurgence- of surgery as the primary treatment is directly attributable to such medical advances as improved anesthesia, well-equipped blood-banks, antibiotic drugs, etc, which have made it possible to extensive radical hysterectomy with minimal operative mortality, Indeed, Meigs and others, have suggested the routine use of Wertheim´s method, which yield good result,
In japan, since prior to the advent of antibiotics, cancer of the cervix is treated by so-called Okabayashi operation as standard therapy, On March, 1941, Prof, Mibayashi urged the necessity of ultraradical operation by his own method in instances of advanced cancer, but it was goon abandoned because of considerable mortality. On the other hand, in America, since 1947. ultraradical surgery, attempted by, Brunschwig, has been utilized in advanced cases. His attemps was successful in the feasibility of the operation
with minimal risk of death.
However, if early, a radical hysterectomy may be utilized, but it is insufficient for advanced degree of cancer. It is essential that ultraradical procedure be performed in advanced cancer.
"The method of Alexander Brunschwig, M, D,"
1. With the patient in Trendelenburg positign, a low midi ine, incision is made, extending upward for´ several centimeters above the umbilicus,
2. The bowels are retracted upward or, if necessary to secure better exposure, the loops of small bowel may be placed on top of the upper abdominal wall to afford more working space in the pelvis and lower abdomen. In not a limited experience in abdominal surgery I have encountered no difficulties as a result of this radical exposure of loops of small bowel. First the right and then left ovarian ligaments and their vessels are divided,. On the right side the rent in the peritoneum thus produced is extended downward abovc the external iliac artery to the anterior abdominal wall and upward to the level of the bifurcation of the aorta into common iliac branches. The common and external iliac arteries are thus exposed. Tice areolar tissue, and lymph nodes along these vessels are stripped away. Blunt dissection is carried downward the toward pelvic floor by gentle insertion of a dissector downward beneath and along the inferior margin of the external iliac vein. The contents of the obturator fossa and the fatty tissues and lymph nodes are freed from Their Ico adhesion to the deep lateral pelvic -Wall and compressed medially.- The obturator nerve is mobilized medially with the latter step but is then separated frpm surrounding tissues by. digital dissection and

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