腹腔鏡的手技を併用し、子宮を温存し得た頸管妊娠の一例

抄録

　Cervical ectopic pregnancy can now be detected relatively early using diagnostic ultrasound technology, but some cases are not detected early and require a hysterectomy due to major bleeding. We report a case in which the uterus was preserved using laparoscopic temporary clipping of the bilateral uterine and ovarian arteries.

　A 32-year-old gravida 1 para 0 woman was suspected of having an ectopic pregnancy in the cervix. She was hospitalized and had decreased levels of human chorionic gonadotropin (hCG) after two cycles of methotrexate (MTX). She was discharged from the hospital but readmitted due to persistent bleeding four weeks after MTX treatment had been initiated. Surgery was performed, during which the uterine and ovarian arteries were temporarily clipped laparoscopically. Bleeding was minimal while curettage of the endocervical canal was performed, and hemostasis was maintained even after the arterial clips were released. The patient recovered well postoperatively, and the hCG level normalized.

　Although conservative treatment with MTX is effective for asymptomatic cervical pregnancy, some patients require surgical intervention. However, any bleeding that occurs is often difficult to stop without performing a hysterectomy. Uterine preservation for this patient was accomplished with laparoscopic temporary clipping of the bilateral uterine and ovarian arteries. It is important to treat cervical pregnancy in a manner that preserves fertility. Laparoscopic temporary clipping of the bilateral uterine and ovarian arteries is minimally invasive and preserves fertility. The procedure can also be performed on obstetric patients who have conditions that may cause massive bleeding, such as placental retention. The technique for exposing the uterine artery is especially important to master and is part of the procedure for safely performing a laparoscopic hysterectomy.