福島医学雑誌 57 巻 4 号　2007

〔原　　著〕

福島赤十字病院産婦人科における内視鏡下手術の現況

矢澤　浩之¹⁾，菅沼　亮太¹⁾，古川　茂宜¹⁾，大関　健治²⁾

¹⁾福島赤十字病院産婦人科，²⁾福島県立医科大学医学部産科婦人科

（受付　2007年7月6日　受理　2007年9月26日）

The Present State of Laparoscopic and Hysteroscopic Surgeries of
Gynecologic Diseases in Fukushima Red Cross Hospital

HIROYUKI YAZAWA¹⁾, RYOUTA SUGANUMA¹⁾, SHIGENORI FURUKAWA¹⁾
and TAKEHARU OOZEKI²⁾

¹⁾Department of Obstertrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, 960-8530, Japan
²⁾Department of Obstertrics and Gynecology, Fukushima Medical University
School of Medicine, Fukushima, 960-1295, Japan

要旨: Minimal invasive surgeryとして普及してきた内視鏡下手術は産婦人科領域においても多くの疾患がその適応となる。2001年10月からの約5年間に福島赤十字病院産婦人科で施行した内視鏡下手術は512件であり，全手術の34%，婦人科良性疾患の59% を占めていた。手術件数は年々確実に増加しており，2006年には120件であった。内訳は，腹腔鏡手術458件，子宮鏡手術54件であった。卵巣腫瘍が最も多く206件（腫瘍摘出129件，附属器摘出51件，開腹移行例26件)，子宮外妊娠では全69件中65件（94%）が腹腔鏡で行なわれた。この内，卵管膨大部・峡部妊娠が57例，卵管間質部妊娠が5例，卵巣妊娠が3例であった。卵管妊娠の術式は，卵管切除術が52件，線状切開術が5件であった。間質部妊娠の1例に子宮外妊娠存続症（PEP: persistent ectopic pregnancy）が発症し，MTXの全身投与による治療を要した。腹腔鏡下腟式子宮全摘術は，子宮筋腫・腺筋症に対して140例に行なっており，術式では，腹腔鏡下に靱帯処理を行なうLAVH (laparoscopically assisted vaginal hysterectomy）が34件，靱帯処理を省略したL-VTH (laparoscope and vaginal hysterctomy）が90件であった。平均手術時間は104分であったが，腹腔鏡下手術手技の向上により，最近の症例ではかなりの短縮が得られている。腹腔鏡手術の合併症では，腸管損傷3件，腹壁動脈損傷5件，重症皮下気腫1件等，子宮鏡手術の合併症では子宮穿孔2件があった。また，術後に悪性腫瘍の診断となった症例が2例あった。内視鏡手術では，特有の合併症を十分に理解してこれを軽減するよう努力し，安全性を最優先に行なうこと重要となる。以上，当院での産婦人科内視鏡下手術の現況を報告した。

索引用語: 腹腔鏡，子宮鏡，産婦人科手術，治療成績，合併症

Abstract: Laparoscopic and hysteroscopic operations are becoming increasingly popular as minimal invasive procedures in gynecologic surgery. In our clinic, 512 endoscopic surgeries have been performed over the five-year period since October 2001. The number of surgeries has increased every year, with 120 operations carried out in 2006. A total of 458 laparoscopic operations and 54 hysteroscopic operations were performed, including 206 cases of ovarian tumors (129 cases of ovarian cystectomy and 51 cases of adnectomy), 65 cases of ectopic pregnancy (94% of all ectopic pregnancy procedure), and 140 vaginal total hysterectomy (VTH). Of the ectopic pregnancies, 57 were tubal pregnancies (isthmus or ammpulla), five were interstitial pregnancies, and three were ovarian pregnancies. Fifty-two salpingectomies and five lineal resections (salpingostomy) were performed as treatment of tubal pregnancy. Persistent ectopic pregnancy (PEP) occurred in one patient with an interstitial pregnancy; she required additional treatment with methotrexate (MTX). In hysterectomy, average operation time of 124 completed cases was 104 minutes. Our laparoscopic operation skills became significantly better with additional experience; we have been able to shorten operating time substantially, especially in recent cases. We observed several complications of endoscopic surgery, including three cases with intestinal injuries, five cases of abdominal wall artery injury, one case of severe subcutaneous emphysema after laparoscopy, and two uterine perforations during hysteroscopy. There were also two cases in which postoperative pathologic diagnosis indicated malignancy, contrary to the expectations. It is critical to understand the unique complications of endoscopic surgery and make an effort at prevention. Safety should be the top priority.

Key words: laparoscope, hysteroscope, gynecologic surgery, treatment result, complication