帝王切開瘢痕部妊娠に対して腹腔鏡下瘢痕部妊娠除去術を施行した一例

抄録

  We report a case of laparoscopic resection of a cesarean scar pregnancy (CSP) in a 29-year-old Brazilian woman who had undergone 4 pregnancies and 4 deliveries (3 via cesarean section). She visited a local physician and was diagnosed with CSP at 7 weeks' gestation; however, because no changes were observed in a gestational sac, she was referred to our hospital. Transvaginal ultrasonography revealed a gestational sac measuring 25 mm attached to the cesarean scar, with thinning of the anterior myometrium and significant bleeding. After confirming that the gestational sac had protruded toward the urinary bladder, we performed laparoscopic resection of the scar pregnancy. We carefully separated the bladder from the site of the pregnancy. A 1:100 solution of vasopressin was locally injected at the site, and we used a monopolar device for incision and resection of the pregnancy tissue. After removal of the scar tissue, 2-layered suture closure of the myometrium was performed, and the site was closed. The operative time was 2 hours 29 min, and the estimated intraoperative blood loss was 5 mL. The patient showed an uneventful postoperative course, and she was discharged on the 4th day. Laparoscopic resection of a cesarean scar pregnancy is associated with a high success rate and is a useful treatment option with few complications. This option is particularly useful in women with a gestational sac located deep within the scar tissue (as was observed in our case). This minimally invasive technique prevents uterine rupture, bladder injury, and/or massive hemorrhage.