臨床婦人科産科75巻9号

2021年09月発行

今月の臨床 産科手術を極める（Ⅰ）―妊娠中の処置・手術

子宮頸管縫縮術の適応―予防的頸管縫縮術・治療的頸管縫縮術・緊急頸管縫縮術の適応と効果

著者： 大槻克文¹

所属機関： ¹昭和大学江東豊洲病院周産期センター

ページ範囲：P.856 - P.865

●頸管縫縮術の適応によって「prophylactic cerclage（予防的頸管縫縮術とほぼ同義）」「ultrasound-indicated cerclage（治療的頸管縫縮術とほぼ同義）」そして「urgent（rescue）cerclage（緊急頸管縫縮術とほぼ同義）」に分類される．

●治療成績に影響を与える因子は残存子宮頸管長とsludgeなどの所見の有無，子宮頸管の炎症の有無などがある．

●頸管短縮例におけるMcDonald法は既往の早産や円錐切除術後など頸管無力症のリスクの高い群では有効であるが，一般症例においては無効である可能性が示唆される．

●細菌性腟炎がなく子宮頸管粘液中顆粒球エラスターゼ陰性が確認されている妊娠16週0日〜26週6日の妊婦で子宮頸管長25.0mm以下の妊婦に対してShirodkar法を実施した場合，切迫早産管理を減少させるという限定的な結果が本邦のRCTで示されている．

●「prophylactic cerclage」の場合，エビデンスレベルの高い報告はない．「ultrasound-indicated cerclage」の場合，子宮頸管長が25mm以下の場合にはその有用性が示されている．特に子宮頸管長が10mm以下の場合には妊娠延長効果が期待できる．「urgent（rescue）cerclage」では頸管の感染の程度が予後を大きく左右する．

＊本論文中，［▶動画］マークのある図につきましては，関連する動画を見ることができます（公開期間：2024年8月末まで）．

参考文献

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