卵管間質部妊娠8例における腹腔鏡下卵管角切除術の検討

Abstract

Interstitial pregnancy is a relatively rare type of ectopic pregnancy. Because intraoperative blood loss is greater than with other ectopic pregnancies, it was hard to perform laparoscopic cornual wedge resection for interstitial pregnancy in the past. Aims: To evaluate the outcome of laparoscopic management of interstitial pregnancy. Methods: Eight patients underwent laparoscopic cornual wedge resection for interstitial pregnancy with or without local methotrexate and vasopressin injection between June 2010 and May 2014 at St. Marianna University School of Medicine Hospital. The preoperative diagnosis, treatment, and outcomes were assessed. Results: Ectopic pregnancy could be diagnosed preoperatively in all 8 patients based on serum HCG, vaginal ultrasonography, and contrast-enhanced computed tomography or magnetic resonance imaging. Interstitial pregnancy was diagnosed in 4 patients. The mean serum HCG level was 16517.0 mIU/ml (3255.3-71407.9 mIU/ml). Laparoscopic cornual wedge resection was performed successfully in 7 patients, but 1 patient required conversion to laparotomy because of abdominal adhesions. The mean of operating time was 121 min (90-151 min) and the mean blood loss was 51g (0-303 g). One patient subsequently achieved intrauterine pregnancy and was delivered by cesarean section. Conclusions: Laparoscopic cornual wedge resection of interstitial pregnancy was performed in 8 patients. Interstitial pregnancy could be diagnosed in 4 patients using serum HCG or imaging. There is an elevated risk of uterine rupture after laparoscopic cornual wedge resection if serum HCG is high or pregnancy is longer than 6 to 7 weeks. Therefore, early diagnosis of interstitial pregnancy is important for successful laparoscopic cornual wedge resection.