帝王切開瘢痕部妊娠に対して腹腔鏡下瘢痕部妊娠切除術が有効であった一例

抄録

　Cesarean Scar Pregnancy (CSP) is an ectopic pregnancy where the embryo implants within a previous cesarean scar. We present a case of laparoscopic uterine scar repair for CSP.

　A 25-year-old woman, gravida 2, para 1, with a history of cesarean section for her first child, presented to her physician at 9 weeks of gestation and was referred to our hospital with a suspected miscarriage. Examination revealed an intrauterine gestational sac corresponding to 7 weeks of gestation, with suspected implantation within the cesarean scar.

　The patient experienced lower abdominal pain and abdominal fluid retention, raising concerns of impending uterine rupture. Emergency laparoscopic resection was performed. During the procedure, the bilateral uterine arteries were clamped using vascular tapes, vasopressin was locally injected around the scar, an incision was made in the myometrial layer, and the gestational sac was excised and retrieved in a bag. The myometrial layer was then sutured in two layers. The surgery lasted 2 hours and 46 minutes, with a blood loss of 10 mL. A levonorgestrel-releasing intrauterine system was placed 2 weeks postoperatively.

　Six months postoperatively, magnetic resonance imaging revealed a myometrial thickness of 10 mm, and the patient was cleared for pregnancy one year post-surgery. Sixteen months post-operation, the patient conceived naturally and delivered via elective cesarean section at 37 weeks and 4 days of gestation.

For suspected incomplete uterine rupture, laparoscopic surgery should be considered the treatment of choice for CSP.