臨床婦人科産科76巻2号

2022年03月発行

今月の臨床 妊娠初期の経過異常とその対処―流産・異所性妊娠・絨毛性疾患の診断と治療

異所性妊娠

卵管間質部妊娠の手術療法

著者： 渡辺正¹ 黒澤大樹¹ 渡部洋²

所属機関： ¹東北医科薬科大学若林病院産婦人科 ²東北医科薬科大学病院産婦人科

ページ範囲：P.247 - P.254

文献概要

●卵管間質部妊娠に対する手術療法には，腹腔側，経頸管側いずれのアプローチからも報告がある．

●卵管間質部妊娠に対する手術療法では，次回以降の妊娠で子宮破裂が起こる可能性がある．

●次回以降の妊娠を希望している卵管間質部妊娠の腹腔鏡手術は，卵管角部切開術が最も勧められる．

参考文献

1）Bhagavath B, et al : Surgical management of interstitial（cornual）ectopic pregnancy : many ways to peel an orange! Fertil Steril 115 : 1193-1194, 2021

2）Tulandi T, et al : Interstitial pregnancy : results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 103 : 47-50, 2004

3）渡辺　正，他 : 異所性妊娠に対する手術②卵管間質部妊娠．臨婦産75 : 834-842, 2021

4）須川　佶 : 子宮外妊娠．産婦人科MOOK No6. pp1-2，金原出版，1979

5）渡辺　正 : 卵管妊娠に対する腹腔鏡下卵管保存手術．産婦の実際60 : 1021-1030, 2011

6）Scarella A, et al : Antenatal diagnosis of a third trimester interstitial pregnancy : A case report. J Obstet Gynaecol Res 38 : 570-573, 2012

7）Wang J, et al : Incidence of interstitial pregnancy after In Vitro Fertilization/Embryo Transfer and the outcome of a consecutive series of 38 cases managed by laparoscopic cornuostomy or cornual repair. J Minim Invasive Gynecol 23 : 739-747, 2016

8）Timor-Tritsch IE, et al : Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 79 : 1044-1049, 1992

9）Izquierdo LA, et al : Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound 31 : 484-487, 2003

10）Takeda A, et al : Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy. J Obstet Gynaecol Res 41 : 1384-1393, 2015

11）Kim TH, et al : Pseudocyst development after treatment for interstitial ectopic pregnancy. Taiwan J Obstet Gynecol 54 : 107-108, 2015

12）Poon LC, et al : How feasible is expectant management of interstitial ectopic pregnancy? Ultrasound Obstet Gynecol 43 : 317-321, 2014

13）Leggieri C, et al : Hysteroscopic methotrexate injection under ultrasonographic guidance for interstitial pregnancy. J Minim Invasive Gynecol 23 : 1195-1199, 2016

14）Groutz A, et al : Successful treatment of advanced interstitial pregnancy with methotrexate and hysteroscopy. A case report. J Reprod Med 43 : 719-722, 1998

15）Procas-Ramon B, et al : Hysteroscopic management of an interstitial ectopic pregnancy. J Minim Invasive Gynecol 26 : 1000-1001, 2019

16）Watanabe T, et al : Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 40 : 1983-1988, 2014

17）Lau S, et al : Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 72 : 207-215, 1999

18）Reich H, et al : Laparoscopic treatment of 109 consecutive ectopic pregnancies. J Reprod Med 33 : 885-890, 1988

19）Meyer WR, et al : Hysteroscopic removal of an interstitial ectopic gestation. A case report. J Reprod Med 34 : 928-929, 1989

20）Ansari A, et al : Robotic-assisted laparoscopic resection of cornual ectopic pregnancy. A case report. J Reprod Med 60 : 58-64, 2015

21）Zhang X, et al : Interstitial pregnancy and transcervical curettage. Obstet Gynecol 104 : 1193-1195, 2004

22）Ahn JW, et al : Ultrasound-guided transcervical forceps extraction of unruptured interstitial pregnancy. BJOG 120 : 1285-1288, 2013

23）Cai Z, et al : The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy : analysis of 22 cases. Arch Gynecol Obstet 285 : 727-732, 2012

24）Nezhat CH, et al : Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-peserving technique. J Minim Invasive Gynecol 21 : 1091-1094, 2014

25）Cervino E, et al : Ultrasound-guided transcervical evacuation of interstitial twin pregnancy. Fertil Steril 96 : 927-930, 2011

26）Wang JH, et al : Single large cystic adenomyoma of the uterus after cornual pregnancy and curettage. Fertil Steril 88 : 965-967, 2007

27）Moawad NS, et al : Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 202 : 15-29, 2010

28）Nirgianakis K, et al : Laparoscopic management of ectopic pregnancies : a comparison between interstitial and “more distal” tubal pregnancies. Arch Gynecol Obstet 295 : 95-101, 2017

29）Svenningsen R, et al : Fertility outcome after cornual resection for interstitial pregnancies. J Minim Invasive Gynecol 26 : 865-870, 2019

30）Yoong W, et al : Novel laparoscopic cornual resection of interstitial pregnancy using the Endo GIATM Universal Stapler（Medtronic） : a series of 12 cases. Aust N Z J Obstet Gynaecol 60 : 130-134, 2020

31）Zheng Y, et al : Laparoscopic blockage of uterine artery in the management of large cornual pregnancy. Fertil Steril 115 : 1350-1352, 2021

32）Cucinella G, et al : Laparoscopic management of interstitial pregnancy : the “purse-string” technique. Acta Obstet Gynecol Scand 91 : 996-999, 2012

33）Gao MY, et al : Interstitial pregnancy after ipsilateral salpingectomy : analysis of 46 cases and a literature review. J Minim Invasive Gynecol 27 : 613-617, 2020

34）Afifi Y, et al : Hemostatic techniques for laparoscopic management of cornual pregnancy : double-Impact devascularization technique. J Minim Invasive Gynecol 23 : 274-280, 2016

35）Ma K, et al : Cornuostomy and cornuectomy : laparoscopic management of interstitial ectopic pregnancies. J Minim Invasive Gynecol 27 : 1480-1481, 2020

36）Lee MH, et al : Comparison of laparoscopic cornual resection and cornuotomy for interstitial pregnancy. J Minim Invasive Gynecol 24 : 397-401, 2017

37）Aust T, et al : Purse-string suture technique to enable laparoscopic management of the interstitial gestation of a heterotopic pregnancy. Fertil Steril 95 : 261-263, 2011

38）Gao B, et al : Laparoscopic strategy for heterotopic interstitial pregnancy following assisted reproductive techniques. JSLS 23 : e2018.00109, 2019

39）Jiang Y, et al : Management and obstetric outcomes of 17 heterotopic interstitial pregnancies. BMC Pregnancy Childbirth 18 : 78, 2018

40）Su CF, et al : Uterine rupture at scar of prior laparoscopic cornuostomy after vaginal delivery of a fullterm healthy infant. J Obstet Gynaecol Res 34 : 688-691, 2008

41）Downey GP, et al : Spontaneous uterine rupture during subsequent pregnancy following non-excision of an interstitial ectopic gestation. Br J Obstet Gynaecol 101 : 162-163, 1994

42）Liao CY, et al : Cornual wedge resection for interstitial pregnancy and postoperative outcome. Aust NZ J Obstet Gynaecol 57 : 342-345, 2017

43）Egger E : Recurrent interstitial pregnancy : a review of the literature. Geburtshilfe Frauenheilkd 77 : 335-339, 2017

44）Siow A, et al : Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol 18 : 296-302, 2011

45）篠崎　悠，他 : 卵管間質部妊娠に対し卵管子宮部楔状切除術後，同側卵管膨大部へ反復妊娠した1例 : 卵管間質部妊娠に対する術式の考察．日産婦内視鏡会誌28 : 581-584, 2012

46）Ng S, et al : Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril 92 : 448-452, 2009