子宮頸部筋腫症例に対する腹腔鏡下子宮筋腫核出術における出血量軽減のための戦略～ネラトン法による子宮動脈血流の一時的遮断～

抄録

  Laparoscopic myomectomy (LM) is currently widely used as surgical treatment for uterine fibroids; however, it may be technically challenging in some patients with cervical fibroids in whom laparotomy needs to be performed. Reportedly, preoperative uterine artery embolization and intraoperative cutting and ligation of the uterine artery reduce intraoperative bleeding during myomectomies. Notably, maintaining maximal uterine blood flow is necessary in patients who desire fertility preservation; unfortunately, currently, no such method is available.

  We describe two patients in whom LM was safely performed using a polyvinyl chloride Nelaton catheter for temporary intraoperative ligation and occlusion of the uterine artery. No major complications were observed intra- or postoperatively in either case. Laparoscopic surgery can be safely performed even in patients undergoing myomectomy for cervical fibroids if intraoperative bleeding is minimal and well controlled. Temporary ligation and occlusion of the uterine artery using a Nelaton catheter reduces intraoperative bleeding and is a simple, minimally invasive, inexpensive and effective strategy in such cases.