卵巣を包有するperitoneal inclusion cystおよび対側の卵管留水症を有する不妊症患者に対して腹腔鏡下手術を施行した一例

抄録

Objective: We report laparoscopic surgery for an infertile woman with a peritoneal inclusion cyst (PIC) surrounding the entire ovary and a hydrosalpinx of the opposite side, which were considered to have been caused by endometriosis and chlamydia infection.

Patient: The patient had a history of untreated chlamydia infection. Ultrasound and magnetic resonance imaging revealed a PIC and a hydrosalpinx. In order to improve chances of conception, the patient underwent laparoscopic surgery. The PIC was formed with a thin layer of tissue lining the left tube and the broad ligament; the left ovary was completely surrounded by the PIC. At the time of surgery, adhesion by endometriosis and a hydrosalpinx of the right tube were observed. The surgery proceeded in the following stages: 1. complete resection of the cyst wall; 2. adhesiolysis between the uterus and the rectum, and also between the right ovary and the broad ligament; 3. removal of endometrial lesions; 4. salpingostomy of the right fimbria.

Conclusion: Surgery for PIC removal to prevent its negative influence on oocyte retrieval and its enlargement during pregnancy is effective for infertile women. Laparoscopic surgery should be the first choice in terms of its minimal invasiveness and curativeness. However, superior laparoscopic surgical skill is required because many PIC cases have extensive adhesion in the pelvis, such as in our case, which makes surgery difficult. As PIC with infertility is expected to also present with a tubal disorder, patients need to be well informed of the treatment plan in advance.