不妊治療後に骨盤内感染をきたし腹腔鏡下手術を施行した７症例の検討

抄録

Objective: The purpose of this study was to identify future issues brought about by pelvic infection after fertility treatment and laparoscopic surgery.

Methods: We retrospectively reviewed the background, surgical details, complications, and course of cases of pelvic infection that underwent laparoscopic surgery after fertility treatment at our hospital from January 2009 to April 2022.

Results: Seven patients aged 31-47 years were included in this study. One had peritonitis only, and the remaining six had tubo-ovarian abscess (TOA), of which five had ovarian endometriotic cysts and one had a mature teratoma. The infection was triggered by intrauterine insemination in two cases, oocyte retrieval in two cases, and embryo transfer in three cases. The median time from onset to surgery for the seven patients was 16 days, and the median time for the five patients who underwent emergency surgery was 7 days. Patients with peritonitis underwent drainage, those with teratoma underwent adnexectomy, and those with endometriotic cysts underwent cystectomy and cauterization. Four patients became pregnant at a later embryo transfer and had live births at term. Complications were not observed, but three cases had reinfection due to resumed fertility treatment.

Conclusions: Laparoscopic surgery can be safely performed for pelvic infections and TOA associated with fertility treatment, and in more than half of the cases, pregnancy was possible in the next cycle or later. However, prolonged hospitalization and recurrence in nearly half of the cases were observed. Earlier surgical intervention and infection prevention during fertility treatment need to be considered in the future.