同側卵管切除後の卵管間質部妊娠の2例

抄録

  Interstitial pregnancy is a relatively rare condition that accounts for 2–4% of all ectopic pregnancies; specifically, interstitial pregnancy after ipsilateral salpingectomy accounts for 0.3–4.0% of all ectopic pregnancies. Its surgical treatment includes cornual wedge resection and cornuotomy. Careful selection of the surgical procedure is important considering reports of onset of persistent ectopic pregnancy (PEP) after surgery and uterine rupture in postoperative pregnancy. In this study, we report two cases of interstitial pregnancy after ipsilateral salpingectomy managed laparoscopically using two different techniques.

  In case 1, the patient who underwent cornual wedge resection was completely cured via surgical treatment alone; in case 2, the patient who underwent cornuotomy developed PEP and required additional treatment. Although cornual wedge resection is a more curative procedure, it yields an increased risk of uterine rupture during postoperative pregnancy. Cornuotomy is useful for patients wishing to preserve their fertility, as it preserves the myometrium and may reduce the risk of uterine rupture in the next pregnancy. Currently, the use of methotrexate therapy is recommended in addition to surgical treatment to prevent the development of PEP.