帝王切開瘢痕部妊娠に対して腹腔鏡下手術後に生児を得た1例—腹腔鏡下手術の有用性と工夫

Successful pregnancy after cesarean scar pregnancy treated by laparoscopic surgery : Utility and scheme of laparoscopic surgery

◆要旨：帝王切開瘢痕部妊娠（cesarean scar pregnancy：CSP）は帝王切開瘢痕部に着床する異所性妊娠である．定型的な治療法は確立されておらず，治療の選択に苦慮することも少なくない．今回CSPに対して腹腔鏡下手術が有効であり，生児を得た1例を経験した．症例は24歳，3妊1産，CSPに対して腹腔鏡下瘢痕部妊娠除去術を行い，1年の避妊期間を経た後，正常妊娠を確認した．2週間ごとに切迫徴候の有無や子宮下節の菲薄化を経腟超音波断層法で評価し，周産期管理を行った．妊娠36週3日に前期破水の診断で緊急帝王切開を施行した．腹腔鏡下手術はCSP治療の選択肢として考慮されるが，術後に挙児を得た報告は少ない．避妊期間や周産期管理に関しては，今後の症例の蓄積が望まれる．

　Caesarean scar pregnancy (CSP) refers to an ectopic pregnancy that is implanted in the scar caused by caesarean section. No standard treatment method has been established, making it difficult to select a treatment. We present a case where laparoscopic surgery was effective for CSP and resulted in a successful birth. The patient was 24 years old and had experienced 3 pregnancies and 1 delivery. Laparoscopic resection of the scar pregnancy was performed for CSP, and the patient became pregnant 1 year later.

　Perinatal period management was performed every two weeks to check threatened premature delivery signs and the lower uterine segment was evaluated using transvaginal ultrasonography.

　We performed emergency cesarean section at 36 weeks and 3 days of pregnancy following premature membrane rupture.

　There are few reports of birth after laparoscopic CSP treatment. We hope that the present case my contribute to future studies of contraceptive periods and perinatal period management for patient who underwent CSP.