腹腔鏡下手術で治療できた腹膜妊娠13例の検討

抄録

  Between March 1991 and July 2019, we performed laparoscopic surgery for 836 ectopic pregnancies, including 13 abdominal pregnancies and one rare case of omental pregnancy. The mean gestational age at the time of treatment was 6 weeks and 5 days, and the mean maternal age was 28.4 years.

  The mean treatment-induced blood loss was 640 mL, and the mean preoperative serum human chorionic gonadotropin (hCG) level was 15,393 mIU/mL. The pouch of Douglas was the predominant site of abdominal pregnancy (n=9), followed by the vesicouterine peritoneum, Fallopian tube surfaces, posterior broad ligament, and the omentum. Laboratory investigations for serum chlamydia antibodies were performed in nine of 13 patients, and only one patient (11%) showed positive results. Coexistent pelvic endometriosis was observed in eight (8/13, 62%) patients, and we encountered the first case of an omental pregnancy, which represents a rare type of abdominal pregnancy. Transvaginal ultrasonography revealed a free hypoechoic area (10 mm) in the pouch of Douglas and thickened homogeneous endometrium without a gestational sac. A mass (46×38 mm) was detected outside the uterine fundus. T1-weighted magnetic resonance imaging revealed a mass (4 cm) showing a high-intensity signal between the left side of the fundus and the left ovary. Laparoscopy revealed an ectopic omental mass (4 cm) originating from the left fallopian tube and extending to the omentum, which was removed using laparoscopic partial omentectomy. Postoperatively, we observed a gradual decline in serum hCG levels in 11 of 13 (84.6%) patients, and two patients with persistent ectopic pregnancy received an intramuscular injection of methotrexate (50 mg). We observed no surgery induced complications. Six of seven women conceived postoperatively, one woman underwent an abortion, and the pregnancy progressed to a live birth in five women. Laparoscopy could successfully treat women with abdominal pregnancies, including a rare omental pregnancy, without any significant complications.