トランス男性に対する子宮・卵巣摘出術

Internal Genital Resection for Transgender Men

はじめに

　子宮全摘術は，子宮筋腫・子宮腺筋症・分娩時の異常出血などの良性疾患をはじめ，子宮癌・卵巣癌などの悪性腫瘍でも行われる産婦人科では標準的な手術である。一方で，性別適合手術（sex reassignment surgery：以下，SRS）としての子宮・卵巣摘出術（内性器摘出術：以下，内摘）は医療提供している施設がわが国では極端に少ない。当院では，2020年7月から婦人科と形成外科でトランス男性（transgender men：以下，TM）に対する内摘と乳房切除術（以下，乳切）を開始した。

　At our hospital, we have started laparoscopic hysterectomy and oophorectomy in the Department of Gynecology, and mastectomy in the Department of Plastic Surgery for transgender men as sex reassignment surgery. Currently, urethral lengthening and total vaginal closure are also carried out, and vaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy is performed as cosmetic surgery. In Japan, the genitals had to be removed as a condition for changing the gender on the patientʼs social registration, but that condition was removed in October 2023. The number of people who want surgery only to remove the uterus and ovaries is decreasing, and those who wish to have a combined surgery such as vaginal closure and mini-penis formation, or a mastectomy at the same time, have come to want internal genital resection as well. There is therefore an increasing need for cooperation between the Departments of Gynecology and Plastic Surgery. In addition, resection of the vaginal mucosa and total vaginal closure increase bleeding. It is essential to re-examine surgical methods and consider issues such as how to utilize the vaginal mucosa. Further experience and an accumulation of cases are necessary.