骨盤臓器脱患者に対する経腟メッシュ手術における術中超音波検査の有用性

The usefulness of intraoperative ultrasonography in the transvaginal mesh（TVM）procedure

　われわれは骨盤臓器脱に対し経腟メッシュ手術を行った35例を対象に，術中にリニアプローブを用いた超音波検査を試み，その結果について検討した。リニアプローブを用いた術中超音波検査で，膀胱壁，腟壁，尿道長，直腸壁の厚さを計測し，液性剝離の状態，剝離部位，穿刺部位，挿入後のメッシュを観察した。全症例において対象部位の観察が可能であった。大量出血，他臓器損傷などの術中合併症は1例も認めなかった。リニアプローブによる術中超音波検査は，解剖学的オリエンテーションの理解，手術手技向上に寄与し，優れたティーチングツールに成り得ると考えられた。

In thirty-five patients with pelvic organ prolapse undergoing TVM procedure intraoperative ultrasonography using a linear probe in TVM procedure was performed. During TVM procedure, transvaginal ultrasonography with a linear probe was used to assess the measurement of bladder wall thickness, vaginal wall thickness, urethral length, rectal wall thickness, the morphology of hydrodissection of the subvaginal space, dissection site, puncture site and the position of the inserted mesh. In all cases, bladder wall thickness, vaginal wall thickness, urethral length and rectal wall thickness were measured. Hypoechoic lesion was identified in the subvaginal space as effective hydrodissection. No vascular lesions were seen in the puncture site. The inserted mesh was visualized as hyperechoic lesion in the subvaginal space. There were no intraoperative complications such as major blood loss and injury to other visceral organs. Intraoperative ultrasonography using linear probe may be useful to understand orientation of pelvic organs, improve surgical technique and become a good teaching tool.