腹腔鏡下子宮全摘術後に卵巣捻転をきたした２例

抄録

　Recent reports demonstrate that approximately 1％ of women experience ovarian torsion following total laparoscopic hysterectomy (TLH). We have performed 1325 cases of TLH over the past 17 years and experienced 2 cases of ovarian torsion following total laparoscopic hysterectomy.

Case 1: A 50-year-old woman who had two previous pregnancies and two successful deliveries. She presented with an enlarged uterine myoma and anemia, which were surgically managed by performing a TLH+bilateral salpingectomy (BS). A 6-cm uterine myoma was removed, and her bilateral adnexa were normal. Six months post-operation, an emergency surgery was performed due to right ovarian torsion. The findings included an edematous and enlarged right ovary, which had twisted 540°; thus, a laparoscopic right ovarian resection was performed.

Case 2: A 44-year-old woman who had three previous pregnancies and three successful deliveries. She presented with back pain that was likely caused by a uterine myoma, which was surgically managed by performing a TLH+BS. An 8-cm cervical myoma was removed, and her bilateral adnexa were normal. Fifteen months post-operation, an emergency surgery was performed due to the torsion of a 6-cm right ovarian cyst. The right ovary was twisted 540°. A laparoscopic right ovarian resection was performed.

　Although it is unclear whether hysterectomy is a risk factor for ovarian torsion, studies have reported that the incidence of ovarian torsion is higher in patients who have undergone a laparoscopic hysterectomy procedure in comparison to those who have undergone an abdominal hysterectomy. Therefore, it is important to consider that TLH may be a risk factor for ovarian torsion and that precautions may be necessary to prevent such in some cases.