卵管間質部妊娠に対し腹腔鏡下に子宮頸部の絞扼駆血を行い卵管角切除術を施行した1例

A woman with interstitial tubal pregnancy who underwent laparoscopic strangulation avascularization in the uterine cervix followed by cornual wedge resection

◆要旨：卵管間質部妊娠の腹腔鏡下手術においては大出血のリスクがあり，出血軽減のための工夫が必要である．筆者らは今回，子宮筋腫核出術を開腹で行う際に用いられる，ネラトンカテーテルによる子宮頸部絞扼法を用いて駆血し手術を完遂した．ネラトンカテーテルはHem-o-lok^®を用いて容易に固定でき，術中出血はきわめて少量で術野も良好に保たれた．癒着や腫瘍などの因子によって実施困難な場合もあるが，本法は出血軽減策の選択肢の1つとして，他の方法や薬物使用を回避できる可能性があり有用と考えられた．

　Laparoscopic surgery of interstitial tubal pregnancy is associated with a risk of massive hemorrhage, necessitating hemorrhage reduction strategies. Herein, we applied a uterine cervix strangulation method using a Nelaton catheter, which is employed for myomectomy, to achieve avascularization, and were able to carry out the surgery. The Nelaton catheter was easily fixed using a Hem-o-lok^®, intraoperative hemorrhage was minimal, and the surgical field was well maintained. Although this method is potentially difficult because of factors such as adhesion and tumors, it may be a useful option for hemorrhage reduction due to the use of other methods or drugs being circumvented.