外来における麻酔および頸管拡張が不要な子宮鏡下子宮内膜ポリープ除去術―LINスネア^®の有用性について―

抄録

Objectives: To evaluate the efficacy of a new snare system for hysteroscopic polypectomy with a small-caliber diagnostic flexible hysteroscope.

Method: We performed a retrospective analysis of 512 women who underwent hysteroscopic polypectomy with a small-caliber diagnostic flexible hysteroscope using the Lin polyp snare system between January 2011 and July 2016 at Kawasaki Municipal Hospital.

Results: The mean age was 39.1±7.4 years (range, 22 to 81 years). Indications for hysteroscopy were infertility (n=201, 39%), abnormal uterine bleeding (n=138, 27%), menorrhagia (n=88, 17%), abnormal ultrasound findings (n=79, 15%), and others (n=6, 1%). In 301 women (59%), polyps were removed by using the Lin snare system, whereas in 182 women (36%), the Lin snare system and a Lin polyp grasper were used. In 17 women (3%), the specimens could not be retrieved after cutting the polyps. The pathological diagnoses were endometrial polyps (n=372, 73%), endometrium (n=67, 13%), endometrial hyperplasia complex (n=10, 2%), atypical endometrial hyperplasia (n=6, 1%), adenomyoma (n=2, 0.4%), atypical polypoid adenomyoma (n=2, 0.4%), endometrioid adenocarcinoma (n=1, 0.2%), leiomyoma (n=1, 0.2%), and cervical polyp (n=1, 0.2%). There were 29 failed procedures (6%). No complications other than bleeding for several days were encountered.

Conclusions: By using the Lin snare system, endometrial polyps can be removed with a small-caliber diagnostic flexible hysteroscope, without requiring cervical dilation, anesthesia, analgesia, or a tenaculum. This procedure may replace blind dilation and curettage for intrauterine pathologic evaluation.