稀少部位異所性妊娠に対する腹腔鏡下手術

抄録

Objective: Ectopic pregnancies (EP) commonly occur in the fallopian tube. As a result of improvements in technology and surgical techniques, laparoscopic surgery is a widely-utilized therapy in cases of EP in the fallopian tube, and also seems to be useful in cases of unusual EP. We aimed to evaluate the efficacy of laparoscopic surgery for unusual EP.

Method: We defined unusual EP as peritoneal pregnancy, ovarian pregnancy, and interstitial pregnancy. We experienced 165 cases of EP from April 2011 to March 2016. Among these cases, 105 cases underwent surgery. 85 cases occurred in a fallopian tube, and 20 cases occurred in an unusual site (peritoneal pregnancy n=5, ovarian pregnancy n=5, interstitial pregnancy n=10.). We retrospectively investigated the clinical features and analyzed treatment from the medical records of unusual EP at our hospital.

Results: Laparoscopic surgery was performed in two cases of peritoneal pregnancies (40%), five cases of ovarian pregnancies (100%), and three cases of interstitial pregnancies (30%). Although in eight cases with unusual EP there was a presentation with massive bleeding, laparoscopic surgery was tried in three of eight cases and completed without conversion to laparotomy. By undertaking intraoperative red blood cell salvage, we were able to could avoid homologous blood transfusion, except in one case.

Conclusion: EP requires emergency treatment, and the diagnosis of unusual EP is particularly difficult. Laparoscopy can facilitate correct diagnosis, results in less physical stress for the patient, and is effective in treatment.