Sziller Istvan, Hupuczi Petronella, Papp Zoltán
1st Department of Obstetrics and Gynecology, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
J Perinat Med. 2007;35(3):187-92. doi: 10.1515/JPM.2007.049.
Ligation of the hypogastric arteries (HAL) was first introduced into surgery by the end of the 19(th) century to control intractable hemorrhage from the uterus of women with advanced cervical cancer. At present, HAL is one in a spectrum of operative methods to control life-threatening postpartum hemorrhage before hysterectomy. Bilateral ligation of the internal iliac artery does not result in complete blockage of but to a significant decrease in blood supply to the female pelvic organs. Soon after ligation three previously existent collateral circulations will develop. Due to the smaller caliber of these arteries, the arterial pulse and pulse pressure are virtually eliminated. The effectiveness of HAL in avoiding hysterectomy for postpartum hemorrhage has been reported in up to 50% of cases. HAL has no adverse effect on subsequent fertility or pregnancy outcome, however, assessment for intrauterine fetal growth restriction is recommended. This safe and effective procedure should be taught during obstetric and gynecologic training.
19世纪末，子宫动脉结扎术（HAL）首次被引入外科手术，用于控制晚期宫颈癌女性子宫的顽固性出血。目前，HAL是子宫切除术前控制危及生命的产后出血的一系列手术方法之一。双侧髂内动脉结扎不会导致女性盆腔器官的血液供应完全阻断，但会使其显著减少。结扎后不久，先前存在的三种侧支循环将会形成。由于这些动脉管径较小，动脉脉搏和脉压实际上会消失。据报道，HAL在避免因产后出血而进行子宫切除术方面的有效性高达50%。HAL对后续生育能力或妊娠结局没有不良影响，不过，建议对宫内胎儿生长受限进行评估。这种安全有效的手术方法应在妇产科培训中教授。
