帝王切開瘢痕部症候群における子宮鏡併用腹腔鏡下瘢痕部修復術の有用性

抄録

　Significant scar defects of the uterine myometrium occur in 4–9% of women who undergo cesarean delivery. Women with prolonged menstruation, abnormal uterine bleeding, and/or secondary infertility attributable to a significant cesarean scar defect are diagnosed with cesarean scar syndrome (CSS).

　The incidence of CSS is expected to increase in Japan owing to the increasing rates of cesarean delivery being observed in obstetric practice. We describe two patients with CSS, who underwent successful minimally invasive surgery using a combined laparoscopic and hysteroscopic approach.

　Case 1: A 35-year-old Japanese woman with a history of cesarean delivery necessitated by arrested labor presented with atypical genital bleeding. Transvaginal ultrasonography (US) and magnetic resonance imaging (MRI) revealed a severe cesarean scar defect, and she underwent combined laparoscopic and hysteroscopic repair for CSS. The entire length of the uterine diverticulum was laparoscopically resected. The light source provided by hysteroscopy was useful during laparoscopic surgery to accurately determine the site and extent of the uterine diverticulum. The incision was laparoscopically closed with absorbable sutures after trimming, and successful surgical repair was confirmed both hysteroscopically and laparoscopically.

　Case 2: A 32-year-old woman who presented with prolonged menstruation underwent US and MRI, which revealed a significant cesarean scar defect. She underwent combined laparoscopic and hysteroscopic repair for CSS, although the method employed differed slightly from that used in Case 1. This treatment led to symptom resolution in both patients. In conclusion, combined laparoscopy and hysteroscopy may be useful for repair of a post-cesarean delivery uterine diverticulum because the site and extent of the uterine diverticulum can be easily determined under hysteroscopic guidance.