Two-step子宮鏡下手術によって子宮温存が可能であった子宮頸管妊娠の1例

抄録

　Ectopic pregnancy accounts for 1-2% of all pregnancies; however, cervical pregnancy is extremely rare and occurs in <1% of all cases of ectopic pregnancies. Reportedly, women with cervical pregnancy may occasionally develop significant hemorrhage during the early stage of pregnancy; bleeding is occasionally difficult to control owing to careless intracervical curettage, necessitating blood transfusion or total hysterectomy. Following the development of novel diagnostic imaging modalities in recent years, cervical pregnancy can be diagnosed at an early stage, and uteruspreserving conservative treatment is currently the common therapeutic approach used for this condition. However, to date, the definitive treatment protocol remains unclear, and individualized therapy is necessary. In this case, we performed two-step hysteroscopic surgery using a small-diameter hysteroscope and resectoscope for the management of cervical pregnancy in a woman in whom systemic administration of methotrexate did not induce spontaneous abortion. We report a case of successful management of cervical pregnancy without hysterectomy and massive bleeding. Smalldiameter hysteroscopy can be performed without cervical dilation (which increases the risk of bleeding) and enables accurate visualization of target lesions, as well as the use of various instruments including scissors, grasping forceps, and bipolar electrodes necessary for the operative procedure. The resectoscope provides a clear view of the surgical field and ensures adequate hemostasis. We conclude that a two-step technique facilitates safer surgery owing to the advantages offered by the aforementioned instruments.