臨床婦人科産科70巻9号

2016年09月発行

今月の臨床 卵管は脇役か？─その生理と病態

卵管の病理

卵管瘤水腫─不妊症での取り扱い

著者： 田島博人¹ 浅田弘法¹

所属機関： ¹新百合ヶ丘総合病院産婦人科／リプロダクションセンター

ページ範囲：P.823 - P.828

文献概要

●卵管瘤水腫はその重症度で大きく治療方針が異なり，軽症例では腹腔鏡下卵管采形成術や開口術，癒着剝離術によって自然妊娠が十分見込める一方，重症例では術後妊娠成績は厳しい報告が多い．

●卵管瘤水腫に対する術式は，重症度に加え患者年齢や背景，卵巣予備能などを総合的かつ慎重に判断し，安易な切除や逆に不利益となる温存を回避するため，術前の十分なインフォームド・コンセントが重要である．

●体外受精の際にも卵管瘤水腫の存在は，着床へ悪影響を及ぼすことが数多く報告されており，胚移植前に外科的処置によって卵管貯留液の子宮内流入を防ぐことが妊娠成績の向上につながる．

参考文献

1）長田尚夫 : 不妊女性に対する手術療法の位置づけ．臨婦産70 : 154─165, 2016

2）Namnoum A, et al : Diagnostic and operative laparoscopy. TeLinde's Operative Gynecology, 8th ed. p.389, Lippincott-Raven, Philadelphia 1997

3）Mage G, et al : A preoperative classification to predict the intrauterine and ectopic pregnancy rates after distal tubal microsurgery. Fertil Steril 46 : 807─810, 1986

4）Audebert A, et al : Laparoscopic surgery for distal tubal occlusions : lessons learned from a historical series of 434 cases. Fertil Steril 102 : 1203─1208, 2014

5）Saleh WA, et al : Pregnancy outcome after laparoscopic fimbrioplasty in nonocclusive distal tubal disease. Fertil Steril 67 : 474─480, 1997

6）Hesla J : Laparoscopic management of distal tubal disease. Infertil Reprod Med Clinics North Am 8 : 425, 1997

7）Marana R, et al : The prognostic role of salpingoscopy in laparoscopic tubal surgery. Hum Reprod 14 : 2991─2995, 1999

8）Schlaff WD, et al : Neosalpingostomy for distal tubal obstruction : prognostic factors and impact of surgical technique. Fertil Steril 54 : 984─990, 1990

9）Rock JA, et al : Factors influencing the success of salpingostomy techniques for distal fimbrial obstruction. Obstet Gynecol 52 : 591─596, 1978

10）Chu J, et al : Salpingostomy in the treatment of hydrosalpinx : a systematic review and meta-analysis. Hum Reprod 30 : 1882─1895, 2015

11）Patton PE, et al : Results of microsurgical reconstruction in patients with combined proximal and distal tubal occlusion : double obstruction. Fertil Steril 48 : 670─674, 1987

12）Strandell A, et al : Why does hydrosalpinx reduce fertility? The importance of hydrosalpinx fluid. Hum Reprod 17 : 1141─1145, 2002

13）Meyer WR, et al : Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 12 : 1393─1398, 1997

14）Ng EH, et al : Adverse effects of hydrosalpinx fluid on sperm motility and survival. Hum Reprod 15 : 772─777, 2000

15）Daftary GS, et al : Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx. Fertil Steril 87 : 367─372, 2007

16）Zeyneloglu HB, et al : Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril 70 : 492─499, 1998

17）Camus E, et al : ［Hydrosalpinx and fertilization in vitro-embryo transfer : abstention or salpingectomy? Abstention, salpingectomy or salpingostomy?］. Gynecol Obstet Fertil 29 : 466─473, 2001

18）Dechaud H : Hydrosalpinx and ART : hydrosalpinges suitable for salpingectomy before IVF. Hum Reprod 15 : 2464─2465, 2000

19）Johnson N, et al : Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev （1） : CD002125, 2010

20）Murray DL, et al : The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rates and the benefit of surgical correction. Fertil Steril 69 : 41─45, 1998

21）Kontoravdis A, et al : Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril 86 : 1642─1649, 2006

22）Bloechle M, et al : Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra. Hum Reprod 12 : 703─705, 1997

23）Hurst BS, et al : Hydrosalpinx treated with extended doxycycline does not compromise the success of in vitro fertilization. Fertil Steril 75 : 1017─1019, 2001

24）Hitkari JA, et al : Essure treatment of hydrosalpinges. Fertil Steril 88 : 1663─1666, 2007

25）Mijatovic V, et al : Essure hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer in patients with a contraindication for laparoscopy. Fertil Steril 93 : 1338─1342, 2010

26）Galen DI, et al : Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization. J Minim Invasive Gynecol 18 : 338─342, 2011