当院における希少部位異所性妊娠の手術成績と管理の現状

抄録

Objective: We aimed to evaluate the clinical and surgical results for unusual sites of ectopic pregnancy (U-EP) treated at Fukushima Red Cross Hospital.

Materials and Methods: We evaluated the incidence, clinical results, and surgical procedures of U-EP from January 2002 to June 2020. We discussed the current status of U-EP management based on the recent literatures.

Results: During the study, 245 cases of EP were treated surgically, including 24 cases of U-EP (9.8%). The subtypes of U-EP were as follows: 13 cases (5.3%) were interstitial pregnancies (IP), 7 cases (2.9%) were ovarian pregnancies (OP), and 4 cases (1.6%) were peritoneal pregnancies (PP). Laparoscopic surgery was the most common procedure (95.8%); only 1 case of IP was primarily treated with laparotomy. For IPs, serum human chorionic gonadotropin levels were higher than with tubal pregnancy and intraperitoneal bleeding were less than with other EP sites, but no cases with rupture were identified. As surgical procedures, cornual resection and cornuotomy were selected in 7 and 6 cases, respectively.

Conclusion: IP has been reported to be associated with a higher risk of massive intraperitoneal bleeding once it ruptures, and OP and PP have higher risk of intraperitoneal bleeding earlier during pregnancy. Earlier preoperative diagnosis and appropriate surgical intervention for EP are required, especially for U-EP, although the identification of U-EP implantation sites is difficult. As clinical evidence regarding medical and expectant treatment for U-EP are poor, strict management is important when these therapies are selected.