帝王切開後瘢痕に発生した稀少部位（腹壁）子宮内膜症の3例

Three Cases of Endometriosis on a Cesarean-section Scar at a Rare Site (Abdominal Wall)

はじめに

　子宮内膜症とは，子宮内膜類似の組織が子宮外に発生する疾患である。局所において子宮内膜が増殖することで，炎症や線維化による組織の損傷や狭窄が生じる。そして，それらによって疼痛や病巣における月経様出血が起こるとされている 1）。全身のいずれの部位にでも発生する可能性があるが，部位により発生頻度が異なる。子宮内膜症のうち，発症部位が骨盤外であるものの頻度は低く，稀少部位子宮内膜症と呼ばれている。

　今回われわれは，帝王切開後の切開瘢痕部に発生した稀少部位子宮内膜症の1つである腹壁子宮内膜症を1年間のうちに3例経験したので，若干の知見を含めて報告する。

　Among the many cases of endometriosis that occur each year, endometriosis occurring in the abdominal wall is considered relatively rare. We treated three patients with endometriosis of the abdominal wall who underwent surgery after being diagnosed with a subcutaneous mass consistent with a cesarean scar. The three women were aged 28–29 years. All had a history of a single cesarean section and were aware of subcutaneous masses and symptoms associated with menstruation 3–5 years after the cesarean section. The respective masses were 2, 3, and 4 cm, and all had adhesions to the anterior sheath which were removed in one lump with a partial or total excision of the anterior sheath. No recurrence was noted at 1–7 months postoperatively. Each case was considered typical abdominal-wall endometriosis, with induration consistent with the cesarean-section scar site and associated with menstruation. However, since there have been reports of endometriosis cases with non-typical symptoms and locations, it is important to keep abdominal wall endometriosis in mind when patients with subcutaneous tumors that develop around gynecologic surgical scars are encountered.