臨床婦人科産科75巻7号

2021年07月発行

今月の臨床 専攻医必携！ 術中・術後トラブル対処法―予期せぬ合併症で慌てないために

婦人科編

子宮筋腫核出術―LM・LAM・TCR・AM

著者： 恒遠啓示¹ 大道正英¹

所属機関： ¹大阪医科薬科大学産婦人科学教室

ページ範囲：P.654 - P.659

文献概要

●筋腫核出術は，コンパートメント症候群のリスク回避のためにも，手術時間が長くならない術式を選択すべきである．

●筋腫核出術は術中失血量を減らすためにmyoma pseudocapsule（MPC）を意識し，MPCを破壊しないように丁寧に行うべきである．

参考文献

1）Ryan GL, et al : Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol 48 : 312-324, 2005

2）Wallach EE, et al : Uterine myomas : an overview of development, clinical features, and management. Obstet Gynecol 104 : 393-406, 2004

3）Tinelli A, et al : Surgical management of neurovascular bundle in uterine fibroid pseudocapsule. JSLS 16 : 119-129, 2012

4）Tinelli A : Uterine fibroid pseudocapsule : an update of its importance in fibroid management and female reproduction. Int J Gynecol, Obst Rep Res 1 : 7-10, 2014

5）西村良平，他 : Myoma pseudocapsuleを意識した筋腫核出と縫合〜Bottomを拾わない〜．日産婦内視鏡会誌35 : 404-408, 2019

6）De Falco M, et al : Leiomyoma pseudocapsule after pre-surgical treatment with gonadotropin-releasing hormone agonists : relationship between clinical features and immunohistochemical changes. Eur J Obstet Gynecol Reprod Biol 144 : 44-47, 2009

7）Rossetti A, et al : Long-term results of laparoscopic myomectomy : recurrence rate in comparison with abdominal myomectomy. Hum Reprod 16 : 770-774, 2001

8）Alexander GD, et al : A safe dose of vasopressin for paracervical infiltration. Anesth Analg 81 : 428, 1995

9）森田峰人，他 : 腹腔鏡下子宮筋腫核出術における子宮壁切開方向と縫合操作に関する一考察．日産婦内視鏡会誌14 : 91-94, 1998

10）Ulmer T : The clinical diagnosis of compartment syndrome of the lower leg : are clinical findings predictive of the disorder? J Orthop Trauma 16 : 572-577, 2002

11）Anema JG, et al : Complications related to the high lithotomy position during urethral reconstruction. J Urol 164 : 360-363, 2000

12）Svendsen LB, et al : Muscle oxygen saturation during surgery in the lithotomy position. Clin Physiol 17 : 433-438, 1997

13）Peters P, et al : Compartment syndrome following prolonged pelvic surgery. Br J Surg 81 : 1128-1131, 1994