骨盤正中部、後腟円蓋後頸部の子宮内膜症病巣の切除

抄録

Objective: To describe the laparoscopic surgical procedure for the removal of endometriotic lesions in the median part of pelvis and the efficacy of the procedure on pain relief.

Design: Retrospective observational study

Setting: A regional medical care support hospital

Patients: A total of 639 patients underwent laparoscopic surgery for the removal of endometriotic lesions from 2005 to 2016.

Interventions: A trapezoidal incision was made in the median pelvic peritoneum, and the fibrotic lesion was resected from the posterior vaginal fornix and retrocervical region.

Main outcome and measures: Pain symptoms were assessed using a 10-cm visual analogue scale (VAS). Recurrence was diagnosed when a patient complained of pelvic pain 100 days after the surgery.

Results: The endometriotic lesions were localized in the medial part of the pelvis. The lesions were resected through a trapezoidal incision in the pelvic peritoneum. Complications including vaginal lacerations and burns were observed in 18 cases, without any serious organ injury. Dysmenorrhea improved from 6.3 ± 2.6 (mean ± SD) to 1.4 ± 2.1, and chronic pelvic pain improved from 3.7 ± 3.0 to 0.2 ± 0.9. In 84.6% of the cases, the VAS level of dysmenorrhea decreased to less than 4 and that of chronic pelvic pain to less than 2 after the surgery. Recurrence of pain was observed in 26.5% of the cases.

Conclusions: Laparoscopic removal of endometriotic lesions from the posterior vaginal fornix and retrocervical region using a trapezoidal incision in the median pelvic peritoneum is feasible without significant complications and is effective in reducing pelvic pain.