腹腔鏡下に片側子宮を摘出した子宮奇形の2症例

抄録

  An obstructed hemiuterus is very rare, and causes dysmenorrhea, infertility and perinatal complications. Here, we describe two patients with obstructed hemiuterus that was managed by laparoscopic surgery. Case 1: A 27-year-old nulliparous woman presented with drug-resistant dysmenorrhea, chronic pelvic pain and hypermenorrhea. Magnetic resonance imaging (MRI) revealed a right unicornuate uterus continuing to the uterine cervix and vagina, a rudimentary left uterine horn and bilateral ovarian cysts. Hysterosalpingography revealed a right uterine horn with a solitary patent tube. Laparoscopic resection of the left rudimentary horn and bilateral ovarian cystectomy proceeded. Postoperatively, she can control dysmenorrhea with low-dose estrogen-progestin. Case 2: A 35-year-old nulliparous woman, presented with dysmenorrhea and infertility problems. Computed tomography (CT) and MRI revealed a left unicornuate uterus with myoma, a rudimentary left uterine horn and left renal agenesis. Hysterosalpingography revealed a left uterine horn with a solitary patent tube. Laparoscopic resection of the right rudimentary horn and myomectomy proceeded. Postoperatively, she remains free of dysmenorrhea. We noted the four points, during laparoscopic surgery. First, we clarified the anatomical construction by first conduction division of adhesion, ovarian cystectomy and myomectomy. Secondly, the difference in the connection state between the unicornuate uterus and the rudimentary uterine horn. Third, whether the affected uterine artery flows into the rudimentary uterine horn. Fourth, after conducting uterine body amputation, we could accurately grasp the cutting plane line of cervical using pelvic examination finger. Our findings suggest that laparoscopic surgery is effective for treating dysmenorrhea associated with a non-communicating rudimentary uterine horn.