鼠径部子宮内膜症に対して腹腔鏡を併用した外科的アプローチを行った3例

抄録

  We report three cases of women with inguinal endometriosis who were treated with conventional extracorporeal excision and laparoscopy. Case 1: A 38-year-old woman complained of a painful nodule in the left inguinal region. Magnetic resonance imaging (MRI) revealed a 2-cm fibrous tumor at the left inguinal region presumed to be an endometriotic lesion. We performed an extracorporeal tumor excision and laparoscopy. The patient had pelvic endometriosis. The left inguinal tumor was excised and endometriosis was confirmed histologically. Case 2: A 40-year-old woman with previous history of ovarian endometrioma cystectomy presented with left inguinal swelling and pain during menstruation. MRI revealed a 2-cm fibrous tumor in the left inguinal region presumed to be endometriosis. Extracorporeal tumor excision and laparoscopy were performed. Endometriosis was confirmed histologically. Her symptoms improved after surgery, but four months after the first procedure, she noticed recurrence of the left inguinal tumor. She underwent a re-excision of the tumor along with inguinal hernia surgery (protrusive approach, mesh plug procedure). Case 3: A 35-year-old woman with a painful right inguinal nodule, suspected to be endometriosis, was treated with extracorporeal tumor excision and laparoscopy. During surgery, in addition to the presence of pelvic endometriosis and peritoneal adhesion, right inguinal hernia was diagnosed and inguinal hernia surgery (Hybrid-TAPP; transabdominal pre-peritoneal approach procedure) was performed along with the excision of the right inguinal tumor by a general surgeon. After surgery, she was symptom free with the support of oral contraceptives. Inguinal endometriosis is rare, but may need appropriate surgical and medical interventions. We discuss the clinical management for inguinal endometriosis and the significance of laparoscopy in such cases.