先天性子宮頸部低形成症に対し、自己腹膜を用いた腹腔鏡下子宮頸部形成術を施行した一例

抄録

  Congenital cervical atresia is an extremely rare condition that is often accompanied with vaginal agenesis and uterine malformations; therefore, its management remains controversial. Here, we present the case of a 17-year-old female with primary amenorrhea. After examination and investigation, she was diagnosed with isolated congenital cervical atresia. We conducted laparoscopic assisted reconstruction. After harvesting a portion of the peritoneum in the pelvis, we laparoscopically incised the anterior wall of the uterus to confirm uterine cavity definitely and transvaginally punctured the uterine cervix from external os to internal os using a needle. Next, we dilated the uterine cervix and lined the peritoneal graft by using a pigtail catheter at the reconstructed cervical canal for early epithelization and restenosis prevention. Thereafter, we inserted the levonorgestrel-releasing intrauterine system to prevent postoperative intrauterine adhesion and immediate menstruation. However, the patient needed to undergo surgery again to remove this system because of perforation in the uterine cavity.

  Consequently, the patient experienced spontaneous regular menstruation for 30 months. Although a longer follow-up is needed to monitor for restenosis, this case shows that laparoscopically assisted surgery and autologous peritoneum are safe and effective for treating congenital cervical atresia.