日本産科婦人科内視鏡学会雑誌
Online ISSN : 1884-5746
Print ISSN : 1884-9938
29 巻, 2 号
選択された号の論文の27件中1~27を表示しています
投稿論文
原著論文
  • 馬場 眞澄, 穴井 麻友美, 荒金 杏, 岩里 桂太郎
    2013 年 29 巻 2 号 p. 397-401
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: The aim of this study was to evaluate the degree of disease severity of ectopic pregnancy dependent upon whether the hospital that transferred a patient to our institution had an obstetrician.
    Design: From 2009 through 2012, 130 ectopic pregnancy procedures were performed at our institution. We divided the 130 cases into two groups: obstetrician group (transfer from an obstetrician; n = 107), and other specialties (transfers from other physicians; n = 23). We compared the two groups in regard to patient background, symptoms, and preoperative degree of disease severity.
    Results: Transfers from other specialists were in a significantly worse condition in regard to hemoglobin level, degree of intraperitoneal bleeding, and blood transfusions. The patients who underwent a medical examination but had no symptoms were included in the obstetrician group (58.9%), but were not included in the other specialists group. Furthermore, the doctors in the other specialists group examined many patients who showed signs of an acute abdomen, which included many differential diagnoses. These physicians often neglected to order an HCG.
    Conclusions: The severity of the impact of an ectopic pregnancy can be reduced by early consultation to an obstetrician. Therefore, communication between other specialists and obstetricians as well as the dissemination of comprehensive sex education for young women is indicated.
  • 上田 和, 大野田 晋, 鴨下 桂子, 井上 桃子, 鳴井 千景, 森川 あすか, 高橋 一彰, 關 壽之, 黒田 浩, 拝野 貴之, 斉藤 ...
    2013 年 29 巻 2 号 p. 402-407
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objectives: Compared to ovarian cancers, borderline ovarian tumors (BOTs) primarily present at an early stage in younger patients and have an excellent overall prognosis. Clinical management of BOTs during reproductive age has been modified from radical surgery to fertility-sparing surgery. However, the accurate diagnosis of BOTs prior to surgery is currently difficult. The aim of this study was to evaluate the feasibility of the laparoscopic approach for BOTs in terms of clinical outcome, including pre and intra-operative diagnosis.
    Methods: From January 2005 through December 2012, we retrospectively reviewed the clinical and surgical parameters of patients undergoing surgery for epithelial BOTs at our institution.
    Results: A total of 119 BOTs were analyzed. For initial surgery, 111 (93%) underwent a laparotomy, and 8 (7%) underwent laparoscopic surgery. All the cases that underwent laparoscopic surgery were selected under a preoperative diagnosis of adenoma. Among 119 BOTs, 70 (64%) had solid areas and 50 (82%) had contrast enhancements in the tumor that was revealed by magnetic resonance imaging. The accuracy of intraoperative frozen section diagnosis was 84%. The incidence of tumor rupture during surgery was significantly higher in the laparoscopic surgery group compared to laparotomy group (P = 0.0007); however, there was no significant difference in the recurrence rate between stage Ia and Ic (b) patients.
    Conclusions: Pre- and intra-operative characterization of ovarian tumors using enhanced imaging studies and frozen section is clinically important. Although further studies are needed, with appropriate patient selection, laparoscopic surgery might be an acceptable intervention for young women with BOTs.
  • 平田 豪, 祐森 明日菜, 成毛 友希, 古野 敦子, 北川 雅一, 片山 佳代, 大島 綾, 村瀬 真理子, 吉田 浩, 平原 史樹
    2013 年 29 巻 2 号 p. 408-412
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: To investigate the outcome of TLHs (Total laparoscopic hysterectomies).
    Methods: From April 2010 through March 2012, after obtaining informed consent, we reviewed the records of 276 cases of TLH. The following parameters were evaluated: surgery time, blood loss, uterine weight, and complications.
    Results: No blood transfusions were administered; ureter injury, bowel injury, or conversion to laparotomy did not occur for any patient. The complication rate was 5%. The mean surgery time was 151.3±29.4 minutes, the mean amount of blood loss was 92.9±79.0 ml, and the mean uterine weight was 403.0±194.1 g (range: 56-1,940 g).
    Conclusions: These data suggest that our TLH procedures avoid ureter and bowel injury; furthermore, they are effective for even difficult cases such as a significantly enlarged uterus or an obliterated of the cul-de-sac.
  • 板橋 香奈, 中林 稔, 鈴木 研資, 杉浦 由紀子, 小西 久也, 佐山 晴亮, 岡部 葉子, 高田 恭臣, 柿木 成子, 中田 真木, ...
    2013 年 29 巻 2 号 p. 413-416
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Background: In regard to myomectomy carried out using a laparoscope, there has been a recent transition from laparoscopic-assisted myomectomy (LAM) via a small incision to total laparoscopic myomectomy (LM). However, there are few reports documenting that LM is actually less invasive than LAM. Here, we compared the difference in invasiveness between LAM and LM.
    Method: We compared the data from 111 patients undergoing LAM and 85 patients undergoing LM at our hospital, after obtaining informed consent, between January 2009 and December 2012. We limited our analysis to patients in whom the specimen weight was 600 g or lower and excluded those who underwent simultaneous multiple organ surgery, such as surgical manipulation of the ovary. Variables for comparison were: the amount of blood loss, the operative time, the white blood cell count on postoperative day 1, the CRP level on postoperative day 3, and the postoperative maximum score on the VAS scale.
    Results: In the absence of any significant difference in the weight of the extracted specimens, the number of resected myomas was significantly larger in the LAM group. The intraoperative blood loss and the operative time were significantly lower and shorter, respectively, in the LAM group; however, the CRP level on postoperative day 3 and the postoperative maximum score on the VAS scale were significantly lower in the LM group. No significant difference was observed in the white blood cell count on postoperative day 1.
    Conclusion: These results suggest that LM is less invasive than LAM in the early postoperative stage.
  • 中郷 賢二郎, 古田 祐, 野崎 綾子, 前田 悟郎, 定免 裕子, 山田 恭子, 福本 俊, 吉井 一樹, 朝野 拓史, 勘野 真紀, 光 ...
    2013 年 29 巻 2 号 p. 417-423
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: To describe laparoscopic restaging of incompletely staged ovarian cancer and to compare the results with those obtained from conventional restaging via laparotomy in terms of feasibility, perioperative morbidity and prognosis.
    Materials and methods: From July 2004 through September 2007, 16 patients with early stage ovarian cancer underwent laparoscopic restaging. In all patients, a salpingo-oophorectomy was performed at the initial open surgery, together with a hysterectomy, omentectomy, and pelvic lymphadenectomy (LND), in some patients. Laparoscopic restaging procedures were conducted according to FIGO guidelines, which recommended infrarenal paraaortic LND, pelvic LND, and omentectomy. Perioperative parameters, recurrence rate, and overall survival were compared with those of 11 control patients treated by open restaging surgery.
    Results: There were no differences in the number of lymph nodes removed (laparoscopic surgery: 70; open surgery: 66). Compared to the open group, the mean blood loss was less and mean operative time was longer in the laparoscopy group. The incidence of perioperative morbidities was similar between the two groups. After a mean follow-up of 82 months, 2 of the 16 patients in the laparoscopy group suffered a recurrence and one of them died of the disease. There were no differences in overall survival between the groups.
    Conclusions: Laparoscopic restaging of ovarian cancer is feasible and may have advantages over open surgery in terms of lower postoperative morbidity and shorter hospital stay. No differences in prognoses were observed in this small patient series.
  • 望月 亜矢子, 宮部 勇樹
    2013 年 29 巻 2 号 p. 424-428
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Introduction: A laparoscopic-assisted ovarian cystectomy is commonly indicated for a mature cystic teratoma. We report the surgical outcome of our recently-developed novel surgical technique that requires only a suprapubic skin incision.
    Methods: We set up an Alexis™ Wound Protector/Retractor (size: XS) in a 2-3 cm suprapubic incision and mounted a sterile glove. Three 5 mm trocars were inserted into the glove for the subsequent insertion of one 5 mm rigid endoscope and two forceps. After establishing a pneumoperitoneum, beginning at the glove, we used forceps to perform adhesiolysis, application of anti-adhesive material, and relocation of the ovary.
    Results: This surgical procedure was completed successfully in 62 patients (mean age: 28 years; body mass index: 21.5 kg/m2) from February 2009 through July 2013. The mean tumor diameter was 7.7 cm and the mean incision length was 2.8 cm. Dense adhesions were observed in three cases, two of which required insertion of an additional trocar.
    Conclusions: Because this surgical procedure provides good aesthetic results and enables intraperitoneal manipulation, diversified simultaneous surgeries and broader indications for the technique are expected.
  • 町田 弘子, 伊藤 善啓, 山田 昌代, 西尾 元宏, 山本 享子, 大西 賢人, 嘉屋 隆介, 宇都 博文, 張 暁慧, 福岡 佳代, 子 ...
    2013 年 29 巻 2 号 p. 429-433
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Object: Abdominal laparotomy is often performed to treat large ovarian endometrial cysts. We determined the safety and feasibility of performing laparoscopic resection for large endometrial ovarian cysts.
    Design: A retrospective cohort study.
    Methods: Between June 2005 and August 2013, we performed laparoscopic surgery in 534 patients with endometrial ovarian cysts at the Yotsuya Medical Cube Women's Center. Patients with ovarian endometrial cysts were divided into the large-cysts ( ≥ 10 cm) and normal-size cysts ( < 10 cm) groups. In cases of large ovarian endometriosis with severe adhesion, we performed laparoscopic-assisted ovarian cystectomy (LAC) using double balloon catheters, which combined intra- and extra-abdominal procedures with small incisions instead of a large open laparotomy. We compared the rates of operative complication, operative time, amount of bleeding, and pathological findings between the two groups.
    Results: We performed laparoscopic surgery in 45 patients with large ovarian cysts. More patients had high serum CA-125 scores and r-ASRM scores in the large-cysts group than in the normal-size cysts group. Patients in the large-cysts group had severe endometriosis, and we performed the LAC procedure in 14 patients of this group. The average operative time and amount of bleeding were increased in the large-cysts group compared with the normal-size cysts group. However, there were no differences in the operative complications between the groups.
    Conclusion: We performed laparoscopic cystectomy in 45 cases of large severe endometrial cysts without complications. These results suggest that laparoscopic management of large endometrial ovarian cysts is safe and feasible.
症例報告
  • 袖本 武男, 板橋 香奈, 久須 美真紀, 北 麻里子, 小島 聡子, 中尾 美木, 西田 晴香, 根井 朝美, 星野 寛美, 香川 秀之
    2013 年 29 巻 2 号 p. 434-438
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Laparoscopic surgery in the third trimester is extremely uncommon. The enlarging uterus hampers surgical procedures and increases surgical risk. We report a case of a woman who developed an ovarian tumor in the 33rd week of pregnancy.
    Case: The patient underwent laparoscopic surgery in the 33rd week of gestation because of an ovarian tumor. After transvaginal aspiration of its contents, the tumor was extracted, and a cystectomy was performed. She underwent 13 days of tocolysis after the procedure. Her postoperative recovery was uncomplicated except for threatened premature labor; she was discharged home on the 14th postoperative day. She delivered a healthy infant at 39 weeks of gestation.
    Conclusion: Laparoscopic gynecologic surgery can be performed in the third trimester if it is clinically warranted.
  • 福井 聡子, 福原 正生, 合志 礼子, 新谷 可伸, 軸丸 三枝子, 宮原 明子, 江上 りか, 渡邊 良嗣, 中村 元一
    2013 年 29 巻 2 号 p. 439-442
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      We performed a laparoscopic tumorectomy on a uterine tumor in a 36-year old female preoperatively diagnosed as having fibroid. The postoperative pathological diagnosis was perivascular epithelioid cell tumor, a rare mesenchymal tumor with uncertain malignant potential. Afterward, she successfully became pregnant and had a term delivery by cesarean.
  • 田渕 雄大, 岩崎 雅宏, 鈴木 利理, 松浦 基樹, 足立 英文, 鈴木 美和, 明石 祐史, 寺本 瑞絵, 田中 綾一, 斉藤 豪
    2013 年 29 巻 2 号 p. 443-447
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      A 43 year-old woman, gravida 3, para 3, presented with a right inguinal mass. It was growing slowly and associated with cyclic pain during the menstrual cycle. She had no other symptoms such as dysmenorrhea or pelvic pain. On examination, the right inguinal mass measured 50 mm. It was relatively fixed and nontender. Laboratory values were normal, including CA19-9, CA125, and CEA. She had a history of a laparoscopic cholecystectomy at 33 years of age. Magnetic resonance imaging (MRI) showed a multiple cystic lesion with in inguinal fatty tissue or in the inguinal canal; it measured 52 mm at its larger axis. We diagnosed it as inguinal endometriosis and resected the tumor. A 30 × 50 mm cystic tumor was removed; it contained a metallic clip. The pathological examination was reported as endometriosis in a canal of Nuck hydrocele. The origin of the metallic clip was thought to be an instrument, which was used in laparoscopic cholecystectomy, because she had no history of trauma or surgery in the inguinal area. The metallic clip migrated from the cystic duct or the artery of gallbladder, transited the inguinal canal, then fell into the canal of Nuck hydrocele. This is a very rare case of endometriosis in a canal of Nuck hydrocele, which contained a metallic clip.
  • 宮本 真豪, 石川 哲也, 三村 貴志, 長島 稔, 竹中 慎, 清水 華子, 飯塚 千祥, 森岡 幹, 関沢 明彦
    2013 年 29 巻 2 号 p. 448-452
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: Pelvic inflammatory disease (PID) is one of the most common infections in non-pregnant of woman of reproductive age; it involves inflammation of the uterus, fallopian tubes, and/or ovaries that can progress to scar formation comprising adhesions to adjacent tissues and organs. The treatment generally involves use of antibiotic therapy; however, surgical intervention may be necessary if the patient has tubo-ovarian abscesses. We experienced a case in which the diagnosis was difficult and the symptoms did not improve with antibiotic treatment. Laparoscopy was ultimately useful for both diagnosis and treatment of this PID case.
    Case: A 35-year-old woman presented at a local hospital with the chief complaints of vaginal bleeding and proctodynia; no abnormalities were present. The next day, she was admitted to other hospital because of sudden onset of lower abdominal pain; laboratory studies were indicative of inflammation showing WBC 20,700 /μl and CRP 0 4mg / dl. Levofloxacin and piperacillin were administered. However, her symptoms exacerbated; computed tomography (CT) performed on the third day revealed ascites but no abscess formation. She was transferred to our hospital. A culdocentesis extracted purulent fluid. An abscess was not imaged with ultrasound; however, the left ovary was slightly swollen. Neither the right ovary nor the appendix exhibited any abnormalities. Laparoscopic surgery was performed for diagnosis and treatment. Acute inflammation of the pelvic organs, particularly in the left ovary, was present. The purulent fluid was drained, and the acute and inflammatory adhesions were excised; in addition, debridement of necrotic tissue was performed. Following the laparoscopic surgery, the inflammation promptly resolved and her postoperative course was satisfactory.
    Conclusions: Laparoscopic surgery is useful for the diagnosis and treatment of PID that does not improve with antibiotic treatment.
  • 竹中 慎, 森岡 幹, 石川 哲也, 遠武 孝祐, 青野 抄子, 豊澤 秀康, 荒木 美智子, 三村 貴史, 清水 華子, 飯塚 千祥, 宮 ...
    2013 年 29 巻 2 号 p. 453-458
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      An atypical polypoid adenomyoma (APAM) is classified as a benign, mixed epithelial and mesenchymal tumor. It is a broad-based polypoid tumor that rarely arises in the uterus of sexually mature women. We report a case of a woman diagnosed with an APAM. A 40-year-old nulligravida with a chief complaint of dysfunctional vaginal bleeding was found to have a 2 cm tumor in the uterine lower body by an ultrasound examination. An endometrial biopsy detected an APAM and atypical endometrial hyperplasia (AEH). We performed a hysteroscopic transcervical resection (TCR) as well as a dilation and curettage. Endoscopy revealed a 2 cm broad-based polypoid tumor. We could not identify a clear borderline between the normal muscle layer and the APAM. We resected as much of the tumor as possible. The pathological diagnosis was APAM and AEH. The patient wished to preserve her fertility, therefore we administered medroxyprogesterone therapy for the AEH postoperatively. Two months postoperatively, residual APAM was suspected by endometrial biopsy and MRI, therefore we performed a repeat TCR. We could not clearly identify tumor tissue; however, we resected the suspicious area detected by the MRI. The pathological diagnosis was APAM. No recurrence occurred 10 months postoperatively. Although a fertility-preserving procedure for an APAM has not been established, TCR appears to be the procedure of choice for resection under direct vision.
  • 谷村 悟, 松本 多圭夫, 舌野 靖, 飴谷 由佳, 舟本 寛
    2013 年 29 巻 2 号 p. 459-463
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Introduction
      Surgical procedures using meshes for pelvic organ prolapse repair have been reported to cause various complications such as mesh extrusion. Transvaginal sacrospinous ligament fixation without mesh is a useful surgical procedure; however, the surgical field is narrow, making it difficult to perform. Therefore, a procedure that allows the safe identification and suture of the sacrospinous ligament is desirable. In this study, we report a surgical procedure that we developed for laparoscopic sacrospinous ligament fixation and colporrhaphy.

    Case report
      The patient was aged 76 years and had a Pelvic Organ Prolapse Quantification System (POP-Q) stage III uterine prolapse, concomitant with a left ovarian tumor. Using a laparoscopic technique, we performed supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrospinous ligament fixation, and colporrhaphy. No complications occurred during surgery, and the patient has shown no recurrence of pelvic organ prolapse 3 months after the procedure.

    Conclusion
      Our experience with the present case indicates that sacrospinous ligament fixation and colporrhaphy can be successfully performed laparoscopically. Transvaginal and laparoscopic cerclage techniques using the uterosacral ligaments have been previously reported; however, because the uterosacral ligaments are membranous structures, the fixation site has varied among surgeons. On the other hand, the sacrospinous ligament is sufficiently strong for suturing, and fixation strength does not vary among surgeons. Therefore, we believe that the surgical procedure described in this study can be used as a standard surgical technique for laparoscopic pelvic organ prolapse repair without mesh.
  • 篠倉 千早, 平吹 信弥, 松山 純, 松岡 歩, 黒川 哲司, 佐々木 博正, 干場 勉
    2013 年 29 巻 2 号 p. 464-468
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: An ovarian inguinal hernia is extremely rare in adults, and it is usually associated with developmental defects of the genital tract. We present a case of a 95-year-old female with an inguinal hernia containing a huge ovarian tumor (20 cm in diameter).
    Patient: Because of the large inguinal bulge, the patient experienced difficulty in walking. She recalled that the inguinal bulge was approximately 2 cm in diameter when she first noticed it 35 years ago; in addition, it was reducible at that time. Abdominal CT scan revealed a solid inguinal tumor, which was possibly receiving its blood supply from the left ovarian artery. Laparoscopic exploration revealed that the hernia sac was covered by dense adhesions and contained the solid ovarian tumor as well as the left pelvic infundibular ligament. Following adhesiolysis, the ligament was transected laparoscopically. The ovarian tumor was removed through a skin incision. The redundant skin was trimmed; then, an open hernia repair was performed, using woven mesh. Her postoperative course was uneventful, and she was discharged on the fifth postoperative day. The histopathologic diagnosis of the tumor was a Sertoli cell tumor of the ovary.
    Conclusions: A steadily enlarging ovarian neoplasm can become incarcerated in the inguinal canal for a long period of time without strangulation occurring. Although it is rare, an ovarian inguinal hernia should be considered when a groin mass is encountered in an adult female.
  • 蝦名 康彦, 山崎 友維, 白川 得朗, 牧原 夏子, 宮原 義也, 新谷 潔, 中林 幸士, 松岡 正造, 上中 建, 横田 一郎, 苅田 ...
    2013 年 29 巻 2 号 p. 469-474
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      We present a case report of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis that was successfully treated by prompt laparoscopic salpingo-oophorectomy.
    Case: A-35-year-old woman with no relevant medical history was admitted to another hospital after suddenly experiencing psychosis and hallucinations. She developed hypoventilation requiring mechanical support. She was transported to the Department of Neurology in our hospital 14 days after symptom onset. T1-weighted pelvic MRI showed a lesion 17 mm in diameter in her right ovary. As paraneoplastic limbic encephalitis was suspected, she was immediately scheduled for tumor resection the next day. She underwent laparoscopic right salpingo-oophorectomy and was afterward treated with high-dose intravenous methylprednisolone, plasma exchange and intravenous immunoglobulin. Four weeks later, she was able to follow simple commands, although she remained on mechanical ventilation for 10 weeks due to nocturnal central hypoventilation. Anti-NMDAR antibodies were detected in her cerebrospinal fluid. Pathological examination of the removed lesion showed an mature cystic teratoma. The patient was diagnosed as having anti-NMDA receptor encephalitis. She recovered completely and returned to work 8 months after onset of the disease.
  • 英 久仁子, 康 文豪, 笠井 真理, 中村 哲生
    2013 年 29 巻 2 号 p. 475-477
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Isolated fallopian tube torsion is a rare disease; however, a paraovarian cyst may be a factor in inducing torsion. If an ovarian cyst exceeds 6 cm in diameter, the likelihood of adnexal torsion is high; thus, this situation is considered to be an indication for resection. A paraovarian cyst presents an equal likelihood of torsion; therefore, its presence also has a similar surgical indication. We experienced a case of a fallopian tube torsion that occurred with a paraovarian cyst of only 3 cm in diameter. When lower abdominal pain first occurred, this cyst was not considered to be its origin. We diagnosed the torsion three days after the onset of lower abdominal pain by preoperative computed tomography. At laparoscopy, the fimbria of the fallopian tube exhibited necrosis; therefore, we were forced to perform a salpingectomy. The literature contains reports of torsion of a normal fallopian tube and torsion of a hydrosalpinx; thus, it is necessary for gynecologists and emergency department physicians to recognize that tubal torsion can occur under these conditions as well as with a small paraovarian cyst.
  • 長島 稔, 御子柴 尚郎, 野口 有生, 石川 哲也, 三村 貴志
    2013 年 29 巻 2 号 p. 478-482
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      We report a rare case of cervical cystic adenomyoma. It is an extremely rare disesase. A 33-year-old female (gravia 0, para 0) presented with progressive dysmenorrhea. She underwent ovarian cystectomy twice for endmetriosis before. Dysmenorrhea was so severe that medical therapy is only marginally effective. Transvaginal ultrasonography and MRI showed a 2 cm cervical cyst that is located within the uterine muscular. It contained blood within the cystic leigion. Under a diagnosis of cervical cystic adenomyoma, laparoscopic excicion was performed. Pathological findings showed the endometrial glands and stroma within myometrial nodule. Symptom improved dramatically after laparoscopic surgery. Cervical cystic adenomyoma is so rare that we did not think that it was cystic adenomyoma initially. We thought history of surgery is involved in cyst formation. Strong clinical symptom appear in cervical cystic adenomyoma as same as that in uterine corpus.
  • 関山 健太郎, 秦 さおり, 清水 操, 山西 優紀夫, 奥田 亜紀子, 伊藤 美幸, 徳重 誠, 髙倉 賢二
    2013 年 29 巻 2 号 p. 483-488
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. It was first described by Mostoufizadeh and Scully in 1980. Polypoid endometriosis often forms large multiple masses and mimics malignant tumors. Endometriosis typically affects women of reproductive age; however, polypoid endometriosis commonly occurs in older women. We report a case of polypoid endometriosis that occurred in a very young female; it arose from the cervix and extended into the Pouch of Douglas. Although it mimicked a uterine malformation on ultrasound at patient presentation, a correct diagnosis was made by magnetic resonance imaging (MRI) and laparoscopic surgery. The patient is a 16-year-old nulliparous female with an intact hymen. One month prior to presentation at our hospital, she experienced severe lower abdominal pain, fever of 39° Celsius, and heavy menses with clots. This incident represented her first episode of dysmenorrhea and hypermenorrhea. The symptoms resolved spontaneously; however, one month later, she again experienced dysmenorrhea and presented at our facility. A uterine malformation such as a bicornuate uterus was suspected on transrectal ultrasound; however, MRI and laparoscopic surgery revealed polypoid endometriosis of the cervix. The symptoms resolved after excision of the lesion. Postoperatively, she has received oral contraceptive therapy for eight months; the condition has not recurred. When a uterine malformation is suspected on ultrasound, a rare condition such as polypoid endometriosis may be diagnosed by MRI or laparoscopic surgery.
  • 伊藤 真友子, 河村 京子, 西澤 春紀, 河合 智之, 安江 朗, 西尾 永司, 塚田 和彦, 廣田 穰, 藤井 多久磨
    2013 年 29 巻 2 号 p. 489-493
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      We report a case of polypoid endometriosis, which was resolved by a laparoscopic hysterectomy. A 47-year-old woman without any previous history of a gynecologic disorder presented at our hospital for evaluation of a pelvic mass. Magnetic resonance imaging revealed adenomyosis and a mass adjacent to the uterus. The mass had low signal intensity on T1- weighted imaging and high signal intensity on T2-weighted imaging. Polypoid endometriosis was suspected preoperatively. Laparoscopy revealed a dark-red pelvic mass adjacent to uterus. We performed a laparoscopic hysterectomy. Histologic examination revealed polypoid endometriosis with adenomyosis. To the best of our knowledge, this is the first report of polypoid endometriosis was resolved by a laparoscopic hysterectomy.
  • 片岡 惠子, 恒松 良祐, 横田 奈津子, 竹内 麗子, 山本 奈理, 加藤 聖子
    2013 年 29 巻 2 号 p. 494-497
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      A premenarcheal 11-year-old girl with no experience of sexual intercourse had repeated lower abdominal pain since she was 7 years old. Imaging and blood tests on her first visit to our hospital showed no abnormal findings. However, she continued to experience intermittent right lower quadrant abdominal pain, and a year and a half later, presented with severe right lower abdominal pain. Transabdominal ultrasound examination and pelvic contrast MRI showed a pelvic mass of 10cm diameter with no blood flow to the right adnexal area. We suspected torsion of ovarian cyst, and performed laparoscopic surgery to obtain a definitive diagnosis. Laparoscopic surgery showed that her uterus and bilateral ovaries were normal in appearance, but only a stump of the left fallopian tube remained, and the right fallopian tube was twisted 1440 degrees. We performed right salpingectomy, and she was discharged three days after the surgery. Case reports of fallopian tube torsion or oviduct edema in women with no experience of sexual intercourse can be found in the literature, and laparoscopic examination should be considered for minors with repeated lower abdominal pain.
  • 福井 章正, 中島 三佳, 河野 亮介, 川越 秀洋
    2013 年 29 巻 2 号 p. 498-501
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Recently, surgeons have more occasion to perform operations on elderly patients, as the population continues to age. However, very few studies have been made on the safety of gynecological laparoscopic surgery in elderly patients. The maximum age of a patient reported to undergo gynecological laparoscopic surgery was 86 years old. We report a case of laparoscopic salpingo-oophrectomy in an extremely elderly patient. The patient was a 97-year-old, gravia 7, para 6, performance status 0. She underwent medical examination due to abdominal distention, lower abdominal pain and frequent urination. A huge pelvic mass was revealed by abdominal ultrasonography, and was refered to our hospital. Magnetic resonance imaging showed a pelvic multiple cystic mass without solid part. The tumor marker was within normal limits. APA PS was class 2. Laparoscopic salpingo-oophrectomy was performed by epidural and spinal anesthesia. The tumor was a left side paraovarian cyst. After operation, symptoms disappeared. She was discharged without problems three days after operation. It was suggested that extremely elder people can receive operation safely with appropriate examination and management.
  • 岩端 俊輔, 川内 博人, 荻野 弓希子, 板倉 彰子, 高木 綾子, 石川 雅一, 海野 信也, 恩田 貴志
    2013 年 29 巻 2 号 p. 502-507
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      A 14-year-old girl experienced lower abdominal pain of one week's duration that recurred monthly for the past year. Her family physician suspected menstrual molimina and referred her to our facility. On pelvic examination, the vagina was 7 cm long and ended blindly; a cervix was not visible. Transrectal ultrasound and magnetic resonance imaging revealed fluid accumulation at sites thought to be the endometrial cavity and cervix. Menstrual molimina due to a transverse vaginal septum or cervical atresia and partial vaginal aplasia was suspected. Laparoscopic evaluation revealed a symmetrical uterine corpus with a normal appearance. A vaginal incision was made with a scalpel, however, a stoma could not be created. During laparoscopy, the fundus was incised by electrocautery, a uterine probe was inserted, and an incision was made from the vaginal side of the probe tip in an attempt to create a stoma. Due to limited tissue distensibility, suturing the vaginal wall and cervix was difficult. Therefore, we created a stoma under hysteroscopy. Menstrual flow promptly occurred after creation of the stoma. At her 6-month follow-up exam she reported that her menses were regular and not accompanied by severe dysmenorrhea. The stoma has remained functional. For cases of cervicovaginal atresia, a combined laparoscopic and hysteroscopic procedure can resolve the condition.
  • 厚井 知穂, 栗田 智子, 庄 とも子, 荒牧 聡, 稲垣 博英, 柴田 英治, 蜂須賀 徹
    2013 年 29 巻 2 号 p. 508-513
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Disorders of sex development (DSD) are defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical. In some cases of DSD, especially 46,XY DSD and Turner syndrome (+Y), early bilateral gonadectomy is recommended; this recommendation is based upon the high incidence of gonadal tumors in affected individuals. Because these cases are frequently found in younger women, laparoscopic surgery is an excellent choice for minimally invasive treatment. We performed a prophylactic laparoscopic gonadectomy on three patients at the appropriate time after carefully determining the correct diagnosis.
  • 白銀 透, 菊地 研, 山下 陽一郎, 武田 直毅
    2013 年 29 巻 2 号 p. 514-519
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Cases of an acute abdomen caused by a rupture of an ovarian endometrioma commonly occur. We report a case of an acute abdomen that was not caused by a rupture of ovarian endometrioma' rather, it was due to an intracystic hemorrhage with a large hematoma within an ovarian endometrioma. The patient was a 29-year-old, gravida 1, para 0 single woman. MRI revealed a left ovarian intracystic hemorrhage with a hematoma (7.0 × 7.0 cm) within the cyst (12.2 × 9.0 cm). On admission, she was in relatively good condition, with normal laboratory findings. Moreover, she preferred to avoid surgery. Thus, conservative therapy was administered. Eight days after admission, CA125 (217.0 IU/ml), CA19-9 (75.8 IU/ml) and D-dimer (1.1 μg/ml) were elevated; in addition, slight leakage of liquid contents from the ovarian cyst into the vesicouterine excavation was noted. Rupture of an ovarian endometrioma was suspected; however, her condition and other laboratory data were within normal limits. Since she declined surgery, she was discharged the next day and followed as an outpatient. During outpatient care, CA125 and CA19-9 gradually normalized and the ovarian cyst shrunk (9.0 × 6.0 cm) as the hematoma dissolved. She underwent a laparoscopic cystectomy of the left ovarian cyst six months after the initial consultation. The histopathologic diagnosis was a benign endometrioma. This case showed that a large endometrioma can cause an acute abdomen due to intracystic hemorrhage forming a large hematoma. As this is not an intraperitoneal hemorrhage, the symptoms are mild; however, rupture is possible. Therefore, such a case requires meticulous follow-up and appropriate treatment.
  • 南 千尋, 横山 幹文, 赤澤 宗俊, 濱崎 洋一郎, 竹内 正久, 瓦林 靖広, 河本 裕子, 妹尾 大作, 本田 直利
    2013 年 29 巻 2 号 p. 520-524
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
    Objective: To present a case of cesarean scar pregnancy(CSP)undergoing a hysteroscopic resection of the villi following temporal laparoscopic uterine artery ligation
    Case: A 31-year-old woman, with a past history of two cesarean sections, presented a chief complaint of irregular vaginal bleeding. The diagnosis of CSP was made by ultrasonography when a gestational sac was detected in the area of the cesarean scar. In addition, an examination of contrasted computed tomography showed that the gestational sac was depicted in the same area. The level of serum hCG was 2694mIU/ml. We laparoscopically ligated uterine arteries on both sides with vessel tapes. The villi were confirmed to be located in the cesarean section scar portion. We completely resected the villi through a hysteroscope. No bleeding from the scar section appeared after the ligations of the uterine arteries were released. The serum hCG level rapidly decreased in the postoperative period. It was demonstrated that the procedures shown here could be safely performed as a treatment for CSP.
  • 永井 富裕子, 青井 裕美, 國見 聡子, 河村 彩, 山田 敦子, 小泉 朱里, 山口 貴史, 須賀 新, 糸賀 知子, 西岡 暢子
    2013 年 29 巻 2 号 p. 525-528
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Atypical polypoid adenomyoma (APAM) is an endometrial tumor that arises from the uterine corpus or cervix in premenopausal woman. Although APAM is pathologically benign, it should be distinguished from atypical endometrial hyperplasia and complex invasive endometrial adenocarcinoma (G1) because these conditions are similar and often coexist. We report a patient with APAM treated with hysteroscopic transcervical resection (TCR). The 28-year-old nullipara patient had hypermenorrhea for 1 year and genital bleeding for 3 months. Ultrasound and MRI revealed a 27 mm×12 mm tumor in the uterine cavity, which was considered to be an endometrial polyp or submucosal myoma. TCR was performed after GnRHa administration for 3 months. Pathological diagnosis showed APAM. Dilatation and curettage was performed 1 month after surgery, showing several residual atypical glands of APAM. The patient was followed every 3 months, and no recurrence of APAM has been detected for 1.5 years. Although clinical management of APAM has not been established, TCR is a reliable procedure for conservative treatment under careful follow-up.
手術手技
  • 近藤 壯, 塩野入 規, 増澤 秀幸, 横井 由里子, 塩沢 功
    2013 年 29 巻 2 号 p. 529-534
    発行日: 2013年
    公開日: 2014/06/16
    ジャーナル フリー
      Adhesions between the abdominal wall and the target organ can be prevented during laparoscopic surgery. However, the anti-adhesion barrier is necessary to prevent adhesion of organs to each other. Seprafilm and Interceed have been used in Japan besides blood products. With Interceed, adhesions will still form if blood remains. Therefore, use of Seprafilm is desirable; however, because Seprafilm is fragile, an appropriate method must be considered when using the Seprafilm in laparoscopic surgery. A variety of using the Seprafilm has been reported in terms of merits and demerits. Here we report a method of making an introducer with an inexpensive culture swab. Culture swabs are sterilized by gamma radiation. The outer diameter corresponds to the inner diameter of 12 mm trocar. Processing is easy as it is made of polyurethane. We used only the outer cylinder of the culture swab. We cut the tip and filled surgical gauze into the lumen in place of the A.P.S. introducer. Each sheet of Seprafilm was divided into 6 pieces, and a total of 182 pieces were inserted into the abdominal cavity for 57 operations. Of the 182 pieces used, 23 (6.7%) were damaged at the time of insertion of the culture swab. We call this method culture swab method. There were no problems in the collection of the samples, because this method does not involve use of a holder when inserting the culture swab into the abdominal cavity. While there was slight damage to the Seprafilm around the culture swab at the time of the insertion, no damage occurred inside the abdominal cavity after insertion. Seprafilm is inexpensive and available everywhere in Japan. Hence, Seprafilm may serve as a useful adhesion barrier.
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