日本産科婦人科内視鏡学会雑誌
Online ISSN : 1884-5746
Print ISSN : 1884-9938
手術手技
ダグラス窩閉鎖を伴う症例に対する腹腔鏡下仙骨子宮靱帯切除術~合併症を減らす工夫~
山中 章義安藤 正明小玉 敬亮白根 晃柳井 しおり中島 紗織福田 美香黒土 升蔵海老沢 桂子羽田 智則太田 啓明
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2015 年 31 巻 1 号 p. 257-263

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  Deeply infiltrating endometriosis (DIE) is defined as subperitoneal invasion by endometriotic lesions. These lesions are considered very active and are strongly associated with pelvic pain. The incidence of DIE is reportedly 20 % in all cases of endometriosis, with uterosacral ligaments representing the most frequent location. Therefore, the resection of uterosacral ligaments is effective in reducing the pelvic pain and dyspareunia that is experienced by patients with endometriosis. However, the operation is associated with a risk of injury to the ureter and rectum; a laparoscopic resection is more useful and safer than open surgery, particularly in patients with adhesion in the pouch of Douglas. Thus, in our study, we initially identified and isolated the ureter and open spaces around the uterosacral ligaments. From June 2012 to December 2013, 262 patients underwent laparoscopic resection of the uterosacral ligaments. Of these, 10 (3.8 %) patients had mild dysuria after the operation, but all cases improved within 2 months. One (0.38 %) patient required clean intermittent catheterization after the operation, which was discontinued 14 months later. Bilateral hydronephrosis occurred in one (0.38 %) patient, which required ureteral dilatation. No ureteral or rectal injury occurred in any patient. Therefore, if the operation is carefully performed, it is possible to safely resect the uterosacral ligaments in patients with endometriosis.

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