腹腔鏡下子宮全摘術の経腟的検体回収による腟壁・会陰裂傷の危険因子の検討

The risk factor of colpoperineal laceration following transvaginal specimen extraction during total laparoscopic hysterectomy

◆要旨：【目的】腹腔鏡下子宮全摘術（TLH）における経腟的検体回収による腟壁・会陰裂傷に関連する危険因子を抽出する．【方法】2014年4月〜2019年4月に施行したTLHで経腟的に検体回収した1,138例を対象とした．裂傷の有無によって2群に分け，患者背景および手術成績を比較した．【結果】51例（4％）で裂傷を認め，経腟分娩歴，術前エストリオール腟錠，子宮重量および横径が裂傷リスクと関連していた．経腟未産婦でもエストリオール腟錠挿入で裂傷のリスクが低下していた．【結論】TLHの経腟回収では検体サイズや分娩歴の考慮のみならず，エストリオール腟錠の挿入による腟粘膜萎縮の改善も裂傷のリスクの軽減に重要と思われた．

　［Aim］ To evaluate the contributory factors for colpoperineal laceration following transvaginal specimen extraction during total laparoscopic hysterectomy （TLH） for benign gynecological disease. ［Patients and methods］ We retrospectively analyzed 1138 cases of TLH between April 2014 and April 2019. The patients were divided into two groups according to the presentation of colpoperineal laceration. The patient characteristics and the surgical outcomes were compared between the groups. ［Results］ Colpoperineal laceration was detected in 51 patients （4％）. There was statistical significance regarding vaginal parity, uterus weight, uterus dimensions （transverse axis） and administration of estriol vaginal suppository between these two groups. In vaginal nullipara group, only administration of estriol vaginal suppository was associated with decreased risk of colpoperineal laceration. ［Conclusion］ The current study suggests that it is important to select appropriate patients by considering uterine size and vaginal parity. Improvement of vaginal atrophy using estriol vaginal suppository is also effective to reduce the risk of colpoperineal laceration following transvaginal specimen extraction during TLH.