臨床婦人科産科71巻4号

2017年04月発行

増刊号 産婦人科画像診断トレーニング─この所見をどう読むか？

生殖・婦人科疾患

症例：不妊診療➌

著者： 升田博隆¹

所属機関： ¹慶應義塾大学医学部産婦人科学教室

ページ範囲：P.203 - P.207

文献概要

この画像をどう読むか？

症例1

34歳女性．未経妊．婦人科的症状はないが，結婚を控えブライダルチェックの経腟超音波検査で子宮内腔病変を指摘された（図1）．結婚後すぐに挙児希望はない．

症例2

29歳女性．1経妊1経産．第1子出産後3年．2児目の挙児希望あるも1年間妊娠せず，産婦人科クリニックを受診し経腟超音波検査にて子宮内腔病変を指摘された（図2）．

Q　上記2症例のうち，治療として手術が妥当であると考えられるものはどれか？（複数回答可）

解答，解説は次のぺージに☞

参考文献

1）Rackow BW, et al : Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril 93 : 2027─2034, 2010

2）Takeda A, et al : Preoperative evaluation of submucosal myoma by virtual hysteroscopy. J Am Assoc Gynecol Laparosc 11 : 404─409, 2004

3）Kalampokas T, et al : Endometrial polyps and their relationship in the pregnancy rates of patients undergoing intrauterine insemination. Clin Exp Obstet Gynecol 39 : 299─302, 2012

4）Zhu H, et al : Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women. Exp Ther Med 12 : 1196─1200, 2016

5）Radwan P, et al : Evaluation of sonohysterography in detecting endometrial polyps-241 cases followed with office hysteroscopies combined with histopathological examination. Wideochir Inne Tech Maloinwazyjne 9 : 344─350, 2014

6）Sadro CT : Imaging the Endometrium : A Pictorial Essay. Can Assoc Radiol J 67 : 254─262, 2016

7）Caserta MP, et al : Through thick and thin : a pictorial review of the endometrium. Abdom Radiol（NY） 41 : 2312─2329, 2016

8）Baldwin MT, et al : Focal intracavitary masses recognized with the hyperechoic line sign at endovaginal US and characterized with hysterosonography. Radiographics 19 : 927─935, 1999

9）Karakas O, et al : Diffusion-weighted MRI in the differential diagnosis of uterine endometrial cavity tumors. Wien Klin Wochenschr 127 : 266─273, 2015

10）Zepiridis LI, et al : Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol 34 : 66─73, 2016

11）Isikoglu M, et al : Endometrial polyps smaller than 1.5cm do not affect ICSI outcome. Reprod Biomed Online 12 : 199─204, 2006

12）Lass A, et al : The effect of endometrial polyps on outcomes of in vitro fertilization（IVF）cycles. J Assist Reprod Genet 16 : 410─415, 1999

13）Yanaihara A, et al : Location of endometrial polyp and pregnancy rate in infertility patients. Fertil Steril 90 : 180─182, 2008

14）Kodaman PH : Hysteroscopic polypectomy for women undergoing IVF treatment : when is it necessary? Curr Opin Obstet Gynecol 28 : 184─190, 2016

15）Perez-Medina T, et al : Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination : a prospective, randomized study. Hum Reprod 20 : 1632─1635, 2005

16）Yang JH, et al : Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy. PLoS One 10 : e0144857, 2015