安全な不妊治療を目的とした腹腔鏡下深部子宮内膜症切除術の適応と手術手技の考察

抄録

　Some women suffer from pain and infertility because of deep endometriosis. We have performed laparoscopic excision of deep endometriosis for infertile women in order to relieve pain and improve fertility. However, according to some reports, excision of deep endometriosis does not always improve the pregnancy rate in fertility treatment after the surgery and has risks of postoperative adverse effect. Therefore, we examined patient background, surgical course, and postoperative pregnancy for laparoscopic deep endometriosis resection at our hospital. Twenty-three patients underwent deep endometriosis resection at our hospital between January 2020 and December 2022. In all cases, not only preoperative explanations of the surgical procedure and complications, but also the need for aggressive postoperative infertility treatment based on intra-abdominal findings and postoperative management, including the possibility of postoperative recurrence and progression, were fully explained to the patients. At the time of surgery, we carefully dissected adhesions from areas where normal anatomy was relatively preserved, keeping in mind that there was deviation from the normal anatomy. There were no serious complications in any of the patients in this study. Postoperatively, 16 pregnancies (69.6％) were achieved at fertility treatment based on the intraperitoneal findings. The mean time to pregnancy after surgery was 8 months (1-18 months). Deep endometriosis resection can be performed safely by pursuing resection of the necessary and sufficient extent of the lesion with adequate preoperative preparation. In addition, we believe that collaboration among the responsible physicians will lead to safe pregnancy and delivery.