Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Assisted reproductive technology procedures infrequently cause pelvic abscesses, but the risk is higher in patients with endometriosis. If antibiotic treatment of a pelvic abscess is unsuccessful, surgery is required-even during pregnancy. We report two patients with endometriosis who suffered from pelvic abscesses formed after egg collection and embryo transfer. Patient 1 underwent laparoscopic resection of the left adnexa and right ovarian cystectomy after diagnosis of the implantation failure. Surgical findings showed severe adhesions in the pelvis due to endometriosis. Patient 2 underwent open drainage surgery at 11 weeks of pregnancy due to pan-peritonitis caused by a pelvic abscess. The patient delivered at 36 weeks of gestation. We conclude that egg collection and embryo transfer in patients with endometriosis confers a high risk for pelvic infection. An accurate diagnosis and appropriate treatment, including surgery, are mandatory in case of severe pelvic abscesses during pregnancy to save both mother and fetus.

DOI： 10.1016/j.idcr.2025.e02184

PubMed

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

中枢性思春期早発症(CPP)は二次性徴の開始が早まる場合と定義され,女児においては多嚢胞性卵巣症候群(PCOS)との関連も示唆されている.今回,PCOS合併CPPにおける大量不正性器出血の症例を経験したため報告する.症例は11歳女児,未妊.2週間以上の性器出血持続のため当院紹介となった.高度貧血と腹痛を認め骨盤部MRIを撮像したところ,多嚢胞性卵巣と腟内血腫を認め,血腫除去を行った.CPPの診断基準を満たしていたため,PCOS合併CPPの診断に至った.標準的治療であるGnRHアゴニストではフレアアップによる出血増加が懸念されたため,GnRHアンタゴニストを投与し,2日目より止血が得られたため,その後退院とした.退院後は半年間GnRHアンタゴニスト投与を継続し,不正出血なく経過している.若年女性の不正性器出血でも大量出血に至る可能性を留意する必要がある.(著者抄録)

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. METHODS: This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. RESULTS: The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). CONCLUSIONS: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.

DOI： 10.3390/biomedicines12061267

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

The abdominal wall is an uncommon site for endometriosis that occurs in the soft tissues of the wound site after laparotomy. The present study reviewed cases of post-cesarean section abdominal wall endometriosis that were surgically treated at our institution from April 2007 to August 2020. We analyzed data from nine patients who were diagnosed with abdominal wall endometriosis and selected surgery after receiving sufficient explanation of hormone therapy and from patients who reported no improvement in symptoms with hormone therapy. Written consent for case reporting was obtained from all patients. The location of abdominal wall endometriosis was at the wound site in seven cases and outside the wound in two cases. In addition, 7/9 (78%) of post-cesarean cases of abdominal wall endometriosis were related to the cesarean procedure, and 6/9 (67%) of the cases had symptoms related to menstruation. Post-cesarean abdominal endometriosis was associated with pain (7/9; 78%) and a palpable mass (3/9; 33%). Surgical resection did not cause large tissue defects, and artificial repairs such as synthetic mesh were not required for any patient. In conclusion, women with a history of a cesarean section who present with recurrent pain or masses in the wound or abdominal wall that coincide with the menstrual cycle should be closely evaluated for abdominal wall endometriosis. Because surgical treatment often requires postoperative wound reconstruction, collaboration with plastic surgeons and dermatologists is essential.

DOI： 10.1272/jnms.JNMS.2024_91-604

PubMed

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

子宮破裂は,比較的稀な疾患であるが発症した場合には母児双方の生命を脅かし,危険な状態になりうる.今回,妊娠12週に子宮破裂の診断で緊急開腹手術を行い,双角子宮の後壁破裂を呈していた症例を経験したので報告する.症例は39歳3妊1産.35歳時に子宮卵管造影検査で単頸双角子宮と診断されている.36歳時に自然妊娠したが妊娠7週で自然流産し子宮内容除去術を行った.37歳時に自然妊娠し妊娠39週で経腟分娩した.いずれも双角子宮左側であった.今回,双角子宮右側に自然妊娠し,妊娠12週0日に下腹部痛と嘔吐を主訴に救急搬送された.来院時ショックバイタルで腹部硬かつ膨満であった.経腟超音波断層法で子宮内に胎児は見られず,腹腔内に広範なエコーフリースペースを認めた.子宮破裂による出血性ショックの疑いと診断し緊急開腹手術を施行した.腹腔内には約3,000mlの血液貯留とその中に臍帯に繋がった胎児を認めた.双角子宮右側後壁に破裂口を認め,両側付属器と双角子宮左側は異常を認めなかった.血腫除去術,双角子宮右側の部分切除術,右卵管切除術,腹腔内洗浄を行った.病理組織学的検査では双角子宮右側の破裂口の近傍に胎嚢の存在を示唆したが,着床異常を示す所見はなかった.異所性妊娠や子宮術後妊娠に起因する子宮破裂の文献は多く散見されるが,本症例のような妊娠初期の子宮破裂の報告は少ない.文献的考察を踏まえ報告する.(著者抄録)

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

腸管子宮内膜症の診断は大腸内視鏡,注腸造影,MRIゼリー法などの侵襲的検査を要する.今回,内診と経腟超音波検査のみで行う子宮内膜症評価法であるNMS-E(Numerical Multi-scoring System of Endometriosis)を用いて非侵襲的に腸管子宮内膜症を診断した1例を報告する.症例は35歳,0妊0産.月経困難症,性交痛,排便痛があり,月経時の血便が出現したため,腸管子宮内膜症が疑われ紹介となった.NMS-Eに基づいた経腟超音波検査により,子宮後面に癒着したstone ring様の像を腸管子宮内膜症性病変として特定した.腹腔鏡下卵巣嚢腫摘出術,深部病変切除術,腸管切除術を行った結果,癒着および深部病変は術前評価と同様であり病理学的にも子宮内膜症性病変として矛盾はなかった.NMS-Eが腸管子宮内膜症の診断手段になりうると示唆された.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.

DOI： 10.3390/diagnostics13101774

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Accurate diagnosis of retroflexed uterus in daily practice is essential because this condition is related to pelvic pain and deep endometriosis. Uterine flexion can be measured by transvaginal ultrasonography (TVUS), a cost-effective primary test, but the accuracy required for diagnosing retroflexed uterus is unclear. This study assessed the accuracy of TVUS for diagnosis of retroflexed uterus in patients with endometriosis and compared it with that of magnetic resonance imaging (MRI) -the gold standard for measuring the uterine axis. METHODS: The study included 123 patients who underwent endometriosis surgery in our department between 2012 and 2017. Uterine flexion angles were measured by retrospectively examining TVUS and MRI images, and the correlation was analyzed. Analysis of anteverted and retroverted uterine subgroups identified aspects of diagnosing uterine flexion with TVUS. RESULTS: Uterine flexion angles on TVUS were strongly positively correlated (r = 0.86) with MRI results. Additionally, TVUS yielded no false-positive diagnoses and 28 false-negative diagnoses of retroflexion. All false-negative diagnoses occurred in patients with anteverted retroflexed uteruses. CONCLUSIONS: TVUS was generally accurate for measuring uterine flexion angle, as indicated by its strong correlation with MRI. Misdiagnosis of anteverted retroflexed uterus was a limitation of using TVUS for retroflexion diagnosis.

DOI： 10.1272/jnms.JNMS.2023_90-106

PubMed

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. MATERIALS AND METHODS: We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. RESULTS: Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. CONCLUSION: We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.

DOI： 10.4103/gmit.gmit_36_22

PubMed

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

腟から腹腔内に貫通して発育し、腹腔鏡下に病変を完全摘出し得たpolypoid endometriosisの1例を経験したため報告する。症例は37歳、0妊0産。29歳時に不正性器出血と月経痛などの疼痛症状を主訴に当院受診。子宮内膜症と診断し、ノルエチステロン・エチニルエストラジオールの内服を開始。30歳時に後腟円蓋から発生する腟内のポリープを認め、切除術を施行したが、再発・増大を繰り返した。36歳時に腟内のポリープの増大と8cm大の腹腔内腫瘤を認めた。精査の上、悪性は否定的とし、腹腔鏡手術を施行。手術所見では、直腸腟中隔にポリープを認め、腟壁を貫通し後腟円蓋のポリープと連続していたため、一塊として病変を摘出し得た。病理診断はpolypoid endometriosisであった。文献的考察を加えると、polypoid endometriosisの好発部位は子宮内膜症の好発部位と一致する可能性が推察された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

著者等は腹腔鏡下卵巣嚢腫摘出術の際に嚢腫の内容物漏出を防ぐため、細径腹腔鏡システムにバスタブ法を併用している。バスタブ法は、ダグラス窩のポートからENDOPOUCHを挿入し、ENDOPOUCH内に嚢腫を留置して内容物が漏出しない状態で嚢腫摘出を行い、ダグラス窩から嚢腫を回収する。本法は、手術操作スペースと小骨盤腔の腹膜をENDOPOUCHで遮断できるため、嚢腫内容物が漏出してもENDOPOUCHが受け止め、骨盤腔への拡散を防ぐことができる。今回、本術式により皮様嚢腫摘出を行い、併存していたparasitic myomaも同時に同様の方法で摘出しえた症例(32歳)を報告した。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02563&link_issn=&doc_id=20230206480020&doc_link_id=10.5180%2Fjsgoe.38.2_113&url=https%3A%2F%2Fdoi.org%2F10.5180%2Fjsgoe.38.2_113&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Publishing type：Research paper (scientific journal)   Publisher：Medknow  

DOI： 10.4103/gmit.gmit_12_20

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(株)診断と治療社  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00525&link_issn=&doc_id=20210824120013&doc_link_id=%2Fae4sanke%2F2021%2F008809%2F014%2F1106-1112%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4sanke%2F2021%2F008809%2F014%2F1106-1112%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

子宮内膜症は、子宮内膜腺・間質組織が子宮内膜以外の部位で増殖する疾患である。なかでも腸管子宮内膜症は、消化器外科との連携がより重要となる疾患である。今回われわれは2011年1月1日から2019年8月31日までの間に当院にて消化器外科と連携し、8例の腸管子宮内膜症の手術症例を経験したので報告する。5例(62.5%)に血便やイレウスなどの消化器症状を認めたが、3例(37.5%)は認めなかった。疼痛症状は全症例に認めた。子宮内膜症の症例において、慢性骨盤痛や排便痛、性交痛など強い疼痛を認める場合には、消化器症状が随伴せずとも腸管子宮内膜症も念頭におく必要がある。精査においては消化器科と相談し内視鏡検査や注腸造影検査も検討する。さらに手術提示の際には腸管切除の可能性も含めた拡大的なインフォームドコンセントが重要となり、他科との十分な連携が不可欠であると改めて認識した。(著者抄録)

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J05048&link_issn=&doc_id=20210126310014&doc_link_id=10.32310%2Fjfpfm.17.1_70&url=https%3A%2F%2Fdoi.org%2F10.32310%2Fjfpfm.17.1_70&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

14歳9ヵ月。月経困難症状の増悪を主訴とした。7歳時に右腎臓無形成を指摘された。経直腸超音波断層法、骨盤部MRI各所見および月経モリミナ症状を有することより、完全閉塞型OHVIRA症候群の疑い、右卵巣子宮内膜症嚢胞と診断した。手術待機期間中、疼痛症状緩和および逆流血減少目的に低用量エストロゲン・プロゲスチン(LEP)配合薬を投与していたが腹膜炎を発症した。緊急腹腔鏡下で右卵巣嚢胞摘出術、右側子宮亜全摘術を行った。病理所見より、卵巣嚢胞は子宮内膜症性嚢胞と診断した。術後、炎症反応は改善、術後1ヵ月に月経が発来し月経困難症状は認めない。本症例はOHVIRA症候群のAcien分類Type5の亜型で、右側子宮の流出路障害により右側子宮留膿腫および右側卵管留膿腫が出現し、腹膜炎をきたしたと考えられた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02563&link_issn=&doc_id=20210204570010&doc_link_id=%2Fcj7sanai%2F2020%2F003602%2F010%2F0153-0157%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcj7sanai%2F2020%2F003602%2F010%2F0153-0157%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：English  

We report a rare case of an ovarian steroid cell tumor with a diagnosis prompted by heart failure symptoms. A 28-year-old Japanese nulligravida/nullipara with a chief complaint of respiratory discomfort during physical exertion and exhibiting heart failure symptoms was referred to our hospital. She also had signs of virilization, including secondary menorrhea since the age of 20, hirsutism and balding. Cushing's syndrome was suspected, and further examinations showed hypertestosteronemia and right ovarian tumor. Symptomatic treatment for heart failure with diuretics and antihypertensives was followed by abdominal right adnexectomy performed due to the androgen-producing ovarian tumor. The tumor was solid and larger than a fist, and confirmed as a steroid cell tumor through postoperative histopathology. Serum total testosterone levels normalized at day 3 postoperatively, and menstruation resumed 2 months later. Our case was diagnosed due to heart failure symptoms, and its treatment resulted in improvement in virilization signs.

DOI： 10.1111/jog.14339

PubMed

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Language：Japanese   Publisher：(株)医学書院  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01564&link_issn=&doc_id=20200706160002&doc_link_id=10.11477%2Fmf.1409210073&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1409210073&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

AIM: To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. METHODS: In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. RESULTS: Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). CONCLUSION: Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

DOI： 10.1111/jog.14191

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：(一社)日本生殖医学会  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

腹腔鏡下子宮筋腫核出術(Laparoscopic myomectomy;LM)は開腹手術に比べ術後疼痛の軽減や入院日数の減少などが期待できる低侵襲な手術であるが,時として多量の出血や手術時間の延長を経験することがある.今回,LMの出血量や手術時間を術前に予測するため,それらに影響を与える因子を解析し,よりリスクが低いLMを施行するための条件を検討した.2015年1月から2017年7月までの間に当科で行なったLM 102例のうち,最大筋腫が漿膜下筋腫の症例では有意に単位時間当たりの出血量が減少するため,漿膜下筋腫の症例を除外した計84例のLMを対象とした.解析の結果,出血量の増加に影響を与える因子は手術時間,最大筋腫直径であった.一方,手術時間に影響を与える因子は筋腫個数であった.したがって,LMにおいて出血量に影響を与える因子は最大筋腫直径,手術時間に影響を与える因子は筋腫個数であることが分かった.出血量400mlを基準としてROC曲線を引くと最大筋腫直径が62mm,また時間を介して筋腫個数3.5個がカットオフポイントになることが判明した.これらは術前に分かる指標となり,この条件に合う症例がより安全なLMを行うための,とりわけ認定医を持たない医師が執刀する良い適応となると考えられた.(著者抄録)

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Language：Japanese   Publisher：金原出版(株)  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated. There was no evidence of recurrence or reoperation in either group for the apical vaginal compartment. Regarding recurrence within the anterior vaginal compartment, there were no significant between-group differences in either of the two randomized controlled trials targeting vaginal vault prolapse. In contrast, in the randomized controlled trial targeting POP including cases with uteruses, there were more recurrent POP with grade II or more in the LSC group than in the ASC group (11/60 [18.3%] vs 1/60 [1.6%], P = 0.004). Reoperation for the posterior vaginal compartment was performed in three cases (2.5%) in the LSC group and in one case (0.8%) in the ASC group. The combined repeat surgery and mesh removal surgery rate was higher in the LSC group (8/119 [6.7%]) than in the ASC group (2/121 [1.7%], P = 0.049). LSC has an excellent therapeutic effect and is comparable to ASC for the treatment of apical prolapse. However, cystocele recurrence, repeat surgery of the posterior compartment, and mesh-related complications were more frequent in patients who had undergone LSC.

DOI： 10.1111/ases.12478

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.gmit.2017.02.001

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The major effector cells for cellular adaptive immunity are CD8(+) cytotoxic T lymphocytes (CTLs), which can recognize and kill virus-infected cells and tumor cells. Although CTLs exhibit strong cytolytic activity against target cells in vitro, a number of studies have demonstrated that their function is often impaired within tumors. Nevertheless, CTLs can regain their cytotoxic ability after escaping from the tumor environment, suggesting that the milieu created by tumors may affect the function of CTLs. As for the tumor environment, the patho-physiological situation present in vivo has been shown to differ from in vitro experimental conditions. In particular, low pH and hypoxia are the most important microenvironmental factors within growing tumors. In the present study, to determine the effect of these factors on CTL function in vivo, we examined the cytolytic activity of CTLs against their targets using murine CTL lines and the induction of these cells from memory cells under low pH or hypoxic conditions using antigen-primed spleen cells. The results indicated that both cytotoxic activity and the induction of functional CTLs were markedly inhibited under low pH. In contrast, in hypoxic conditions, although cytotoxic activity was almost unchanged, the induction of CTLs in vitro showed a slight enhancement, which was completely abrogated in low pH conditions. Therefore, antigen-specific CTL functions may be more vulnerable to low pH than to the oxygen concentration in vivo. The findings shown here provide new therapeutic approaches for controlling tumor growth by retaining CTL cytotoxicity through the maintenance of higher pH conditions.

DOI： 10.1016/j.imlet.2015.07.003

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

J-GLOBAL

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Language：Japanese   Publisher：(株)医学書院  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2015060454

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

AimThe aim of this study was to assess the cut-off age of the risk factors for postoperative recurrence of ovarian endometriomas and to evaluate the end-points of follow-up after laparoscopic excision of ovarian endometriomas.
Material and MethodsWe retrospectively reviewed 167 patients who underwent laparoscopic excision of ovarian endometriomas at our hospital between 2000 and 2009, and followed up the patients until 2010. Following surgery, patients chose to receive gonadotrophin-releasing hormone agonist, oral contraceptive pills (OCP), dienogest, or no medication and underwent regular ultrasonographic examinations. Potential risk factors for recurrence, including age at surgery, were assessed in the patients receiving no medication. Postoperative recurrence, defined as re-appearance of an ovarian endometrioma&gt;2cm in size, was assessed for each treatment group.
ResultsAge at surgery was the only significant risk factor for recurrence, at a cut-off of 32 years, obtained through receiver-operator curve analysis. In patients not receiving medication, the recurrence rate gradually increased up to 50% over 5 years; there was no recurrence 5 years after surgery. Although no recurrence was seen in patients during continuous treatment with OCP or dienogest, the disease recurred in 55.5% of patients after discontinuing OCP.
ConclusionsAlthough adjuvant therapy for all patients may represent overtreatment, the findings of the present study suggest that, in the interest of fertility preservation, continuous postoperative hormonal treatment should be administered, at least to patients younger than 32 years. In patients who decline hormonal treatment, we recommend that they undergo follow-up for recurrence until 5 years after surgery.

DOI： 10.1111/jog.12164

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The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.

DOI： 10.1111/ases.12041

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

腹腔鏡下摘出術を行った卵巣チョコレート嚢胞群20例(平均32.05歳)と、卵巣皮様嚢腫群7例(平均30.43歳)を対象に、術前後に抗ミュラー管ホルモン(AMH)値、卵胞刺激ホルモン(FSH)値、エストラジオール(E2)値を測定し、卵巣予備能との関連について検討した。卵巣皮様嚢腫群では術前後でAMH、FSH、E2値に有意差がなく、チョコレート嚢胞群でもFSH、E2値は術前後で有意差はなかったが、AMH値は術後に有意に低値を示し、卵巣予備能の指標としてより鋭敏である可能性が示唆された。卵巣チョコレート嚢胞群では片側嚢腫(13例)、両側嚢腫(7例)とも術後にAMH値の有意な低下が認められた。卵巣チョコレート嚢胞群13例の術後1ヵ月AMH値は低下したが、術後3ヵ月では10例で再上昇し、術前値に比べた回復率は平均63.0%であった。卵巣チョコレート嚢胞摘出術は卵巣予備能を低下させる可能性があり、AMH値による卵巣予備能評価はFSH値より鋭敏であると考えられた。

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Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect.

DOI： 10.1111/j.1447-0756.2012.01987.x

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Language：English   Publishing type：Research paper (scientific journal)  

Minimally invasive surgery is widely used in gynecology. Women who seek a cosmetic advantage (i.e., concealed scars) choose minimally invasive surgery. Although laparoendoscopic single-site surgery could be an ideal solution, some of our patients have had cosmetic problems, such as pigmentation and cicatrix of the umbilicus. In addition, umbilical eversion and umbilical herniation occasionally develop. Therefore, mini-laparoscopic surgery using 3-mm trocars can be recommended for patients who do not want the natural appearance of the navel to be altered. We have developed an approach to achieve a superior cosmetic outcome by direct placement of 3-mm trocars in the lateral wall of the abdomen and at the lower border of the pubic hair. We refer to this method as mimic mini-laparoscopic surgery and report cases in which this procedure was used.

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Mesh surgeries, such as sacrocolpopexy and transvaginal mesh surgery, are commonly used to treat pelvic organ prolapse. Although mesh surgeries have a high success rate, they are unsuitable for some patients. For a patient with pelvic organ prolapse and highly calcified multiple fibroids, we performed hybrid sacrocolpopexy combined with transvaginal mesh surgery with a method modified for the patient's condition. Three months after surgery, the results were highly satisfactory. This approach is simple, secure, and versatile for patients who are not good candidates for conventional mesh surgeries. This novel hybrid mesh surgery is an option for treating various types of pelvic organ prolapse.

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OBJECTS: Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system. METHODS: This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures. RESULTS: Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min). CONCLUSION: Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.

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DOI： 10.1111/j.1447-0756.2009.01073.x

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AIM: To examine the efficacy of local methotrexate (MTX) administration following linear salpingostomy for tubal pregnancy in the prevention of persistent ectopic pregnancy (PEP). METHODS: Patients who underwent a laparoscopic linear salpingostomy between January 1996 and December 2006 were enrolled in the study. Patients who were assigned to the prophylaxis group were administered MTX (50 mg) into the tubal wall in the vicinity of the lesion immediately following linear salpingostomy (n=41). Patients who were treated without MTX were assigned to the control group (n=40). Serum human chorionic gonadotrophin levels were followed in both groups postoperatively once every 3 days until they became undetectable. The incidence of PEP was compared between the two groups. RESULTS: Persistent ectopic pregnancy occurred in seven patients (17.5%) in the control group compared with zero patients in the prophylaxis group (P<0.05). There were no side-effects attributable to MTX in the prophylaxis group. CONCLUSION: A single prophylactic intratubal injection of MTX following laparoscopic linear salpingostomy is a safe and effective regimen for the prevention of PEP.

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The majority of human and rodent cancers display various antigens which could elicit cellular and humoral immune responses. Such immunity, however, often fails to prevent progressive growth of cancers. It has long been speculated that tumor antigens may not be presented in appropriate fashion, which subsequently fails to elicit a strong immune response. Recent studies, however, indicate that immunization by formulated tumor antigens or even transfer of pre-activated T lymphocytes also have limited impact on cancer growth despite the fact that these methods could often enhance immune responses in cancer patients. These findings imply that even afferent arm of immunity are strengthen, it is not necessarily being translated to tumor regression. It is possible that the development of evasion mechanisms in tumor microenvironment play a critical role in the resistance of therapeutic immune responses. Recent studies provide compelling evidence that human and rodent cancers develop evasion mechanisms by aberrantly expressing normal proteins, which are required for normal tissue homeostasis, to either build a microenvironment locally or reach other organs systemically. In this review, we will focus our discussion on two recently described molecules, B7-H1 and B7-H4, in the context of their roles in the evasion of tumor immunity and possible approaches for therapeutic manipulation.

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Contemporary approaches for vaccination and immunotherapy are often capable of eliciting strong T-cell responses against tumor antigens. However, such responses are not parallel to clinical tumor regression. The development of evasion mechanisms within tumor microenvironment may be responsible for poor therapeutic responses. We report here that constitutive or inducible expression of B7-H1, a B7 family molecule widely expressed by cancers, confers resistance to therapeutic anti-CD137 antibody in mice with established tumors. The resistance is accompanied with failure of antigen-specific CD8+ CTLs to destroy tumor cells without impairment of CTL function. Blockade of B7-H1 or PD-1 by specific monoclonal antibodies could reverse this resistance and profoundly enhance therapeutic efficacy. Our findings support that B7-H1/PD-1 forms a molecular shield to prevent destruction by CTLs and implicate new approaches for immunotherapy of human cancers.

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Language：English   Publishing type：Research paper (scientific journal)  

Recent findings suggest that macrophage-tropic human immunodeficiency virus type 1 (HIV-1) produced in colostrum/early breast milk may hold a clue to determine the mechanisms of transmission of HIV-1 via breast-feeding. Here, we show that the majority of CD4(+) cells in the colostrum are CD14(+) macrophages expressing both chemokine receptors and DC-SIGN, a dendritic cell-specific receptor for HIV-1. The R5-type macrophage-tropic HIV-1 isolate NL(AD8) infected such breast-milk macrophages and caused them to secrete virus particles efficiently; however, the secreted virions showed only a weak transmissibility to their susceptible target, MAGIC-5 cells. When stimulated with interleukin-4, the breast-milk macrophages demonstrated a striking enhancement of expression of DC-SIGN and showed a strong capacity to transmit NL(AD8) virions to MAGIC-5 cells, which was specifically blocked by anti-DC-SIGN-specific antibody. These results suggest that HIV-1 virions captured by DC-SIGN, but not secreted cell-free virions, may be more efficiently transmitted to other compartments, such as the gastrointestinal tract, through acidic gastric juice.

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Peripheral blood monocytes extravasate and differentiate into tissue macrophages to mediate effective local defence, but how tissue-specific stimuli and environments may influence their functions remains unknown. Here, we found that peripheral blood monocytes gained the ability to produce granulocyte-macrophage colony-stimulating factor (GM-CSF) upon exposure to breast milk and differentiated into CD1+ dendritic cells (DCs) in the presence of exogenous interleukin-4 (IL-4) alone. This in vitro observation appeared physiologically relevant since macrophages that were freshly isolated from breast milk were also found to produce GM-CSF spontaneously. Furthermore, in contrast to peripheral blood monocytes that differentiated into DCs only in the presence of both exogenous GM-CSF and IL-4, differentiation of breast milk macrophages into DCs was induced by incubation with exogenous IL-4 alone. These IL-4-stimulated breast milk macrophages were efficient in stimulating T cells, suggesting their potential role in mediating T-cell-dependent immune responses in situ. On the other hand, unexpected expression of DC-SIGN, a DC-specific receptor for human immunodeficiency virus (HIV), even in unstimulated breast milk macrophages, may favour HIV infection, resulting in an increased risk of mother-to-infant vertical transmission of the virus via breast milk. Thus, tissue-specific development of macrophages is often linked to effective local immunity, but may potentially provide an opportunity for a pathogen to spread and transmit.

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：Japanese   Publisher：(一社)千葉県産科婦人科医学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

J-GLOBAL

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Language：Japanese   Publisher：日本外科系連合学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：日本子宮鏡研究会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：日本女性骨盤底医学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

2010年から半年以上フォローできた子宮腺筋症患者32人を対象に、子宮腺筋症に対するレボノルゲストレル徐放型子宮内避妊システム(LNG-IUS)療法におけるGnRHアゴニスト(GnRHa)の有効性について検討した。対象の平均年齢は43.9(32〜51歳)、平均経産回数は0.83回、挿入前の筋層の厚さは平均42.3(20〜80)mmであった。LNG-IUS挿入により、月経痛のVASは半年間で平均8.0から1.9に有意に減少した。GnRHa併用投与例が6例で、いずれも筋層の厚さが40mmを超えていた。GnRHaの併用パターンは先行投与、追加投与、脱出例の3パターンであった。LNG-IUSは子宮腺筋症による疼痛症状を改善し、安価で患者コンプライアンスもよく、治療法の1として非常に有効であった。筋層が厚い症例に対しても。GnRHa併用により治療効果があった。

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

2011年4月〜2016年3月までチョコレート嚢胞によって急性腹症をきたした45例を対象に、後方視的に検討した。緊急手術群27例、待機群18例であった。緊急手術群では有意に腹水貯留を認め、鎮痛薬使用頻度が多かった。27例中、感染で手術したのは11例(感染群)、破裂で手術したのは16例(破裂群)であった。感染群で入院時体温、白血球数、血清CRPにおいて有意に高値であった。診察時に腹水貯留を認め、頻回の鎮痛薬使用でも痛みのコントロールができない場合は手術に至った。急性腹症を呈した原因がチョコレート嚢胞の感染であった症例は炎症所見が前面に出ていた。チョコレート嚢胞の感染は手術療法に踏み切るタイミングが遅くなると治療に難渋した。

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本排尿機能学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

AMH(抗ミュラー管ホルモン)は卵巣予備能の一指標として有用とされ、卵巣子宮内膜症性嚢胞の術後に低下することが知られているが、一定期間後にその値が回復するという報告がある一方で、回復しないという報告もある。そこで今回、AMHの術後回復に寄与する因子について検討した。方法は、当院で2011〜2015年に腹腔鏡下手術を行った卵巣子宮内膜症性嚢胞患者のうち、術前と術後1ヵ月・6ヵ月・1年時にAMH値を測定していた35例のデータを分析した。術後6ヵ月以降のAMH値が術後1ヵ月時よりも20%以上上昇していた20例を&quot;上昇群&quot;、他の15例を&quot;非上昇群&quot;とし、両群間で「年齢」「術前AMH値」「腫瘍径」「CA19-9」「CA125」「AMH変化率」「r-ASRMスコア」などを比較したところ、非上昇群は「年齢」と「r-ASRMスコア」が有意に高かった。

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

NMS-Eとは、子宮内膜症を4つの要素すなわち「卵巣の大きさ」「癒着スコア」「痛みスコア」「子宮とその周辺の病変」分け、内診と経腟超音波検査の所見から各項目を10点満点で評価する簡便な方法であり、算出されたNMS-Eスコアは、従来のr-ASRMスコアと有意に相関することを以前報告した。今回、NMS-Eスコアのうち「癒着スコア」について、複数検者間での一致度を調べることにより、本評価法が再現性のある方法であるか検証した。対象は、当院で2015年6月〜9月に腹腔鏡手術を施行した患者20例とし、検者3名(いずれも産婦人科医)がNMS-Eスコアの評価を行った。結果、「癒着スコア」の一致度(検者間級内相関係数)は0.807と良好であった。

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

6年間に3cm以上の卵巣チョコレート嚢胞に対して腹腔鏡下手術を行った45歳以下の患者215例を対象として、ジエノゲスト長期投与による再発予防効果を検討した。術後管理は経過観察(妊娠希望を含む)群109例、低用量エストロゲン・プロゲスチン配合薬(LEP)群69例、ジエノゲスト群37例であり、ジエノゲスト群の観察期間は36.2±16.3ヵ月で他よりも長く、再発人数は1人で再発時期は8ヵ月であった。また、累積無再発率はジエノゲスト群97.0%、経過観察期間群64.0%、LEP群98.2%であり、ジエノゲスト群は経過観察群に比べて再発が有意に抑制されていたが、LEP群との間に有意差は認めなかった。ジエノゲストは12ヵ月以上の長期使用においてもLEPとともに卵巣チョコレート嚢胞術後の再発予防に選択されるべき薬剤であると考えられた。

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Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

チョコレート嚢胞に対して腹腔鏡下卵巣嚢腫摘出術または患側附属器切除術を行った255例を対象に、術後療法別にジェノゲスト群53例(内服継続群32例、休薬群21例)、LEP群54例(内服継続群36例、休薬群18例)、薬剤投与なし群148例に分け比較検討した。患者背景では、手術時年齢がジェノゲスト継続群でLEP継続群、LEP休薬群に比べ有意に高齢であったが、Re-ASRM score、CA125、追跡期間に有意差はなかった。ジェノゲスト群では、継続群の1例(3.1%)に対側卵巣に再発が認められたが内服継続で消失し、チョコレート嚢胞の再発ではない可能性が高いと考えられた。休薬群の2例(9.5%)に再発が認められた。LEP群で再発は認めなかった。休薬群では妊娠希望が最も多く、ジェノゲスト群で6例、LEP群で9例であり、これを除いた休薬率はジェノゲスト群31.9%、LEP群20%と有意差はなかった。

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

複数のホルモン治療に抵抗性を示す子宮腺筋症患者10例(平均44.9歳)を対象に、LNG-IUS使用前後のビジュアルアナログスケール(VAS)を用いた疼痛評価、不正性器出血の検討、および満足度調査を行った。月経痛は9.2から1.4へ、慢性骨盤痛は9.1から2.0へ有意にVASが減少し、排便痛・性交痛は減少傾向がみられた。LNG-IUS挿入後は全例に不正性器出血が認められたが、使用18ヵ月には80%の患者で認められなくなった。使用12ヵ月において出血を全く認めなかったのは60%、月経周期に沿った少量の出血が20%、以前と比較しての減量持続出血が10%であった。効果、副作用、利便性・QOLおよび全体満足度の合計は60点満点中53.2点と、高い満足度が得られた。

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

ジエノゲストを投与し3ヵ月以上フォローアップできた130例を、投与継続群66例と投与中止群64例に分け、更に治療的投与群と術後再発予防群における投与状況について比較検討した。投与中止群の平均投与期間は229.9日で、70%以上が6ヵ月以内に投与中止となっていた。投与中止理由は不正性器出血が21例と最も多く、特に治療的投与群46例中19例が不正性器出血で中断となっていた。投与継続群においても不正性器出血を35例に認めた。ジエノゲストを初回治療に選択した症例は有意に投与中止となっていた。GnRHアゴニスト投与2ヵ月後にジエノゲストを投与した4例の不正性器出血はごく僅かであった。投与中止群のうち術後病変の再発が認められたのは3例で、投与継続群では再発例はみられなかった。

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：金原出版(株)  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

当科で2000〜2009年に腹腔鏡下卵巣チョコレート嚢胞摘出術を施行した158例の術後経過を後方視的に分析し、その結果をもとに、術後フォローのプロトコールを挙児希望の有無別に策定した。プロトコールの内容は、挙児希望がない場合、術後2週以降の初月経時から低用量ピルやジエノゲストなどの薬物療法を行い、副作用がない限り継続する。挙児希望がある場合には、術直後から性交timingを計るが、筋腫核出術併用例など術直後に妊娠許可が下りない症例では許可が出るまで薬物療法を施行する。性交timingの指導は年齢(35歳未満か以上か)とReASRM分類に応じて実施する。

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

深部子宮内膜症はダグラス窩に認めることが多く、その場合ダグラス窩は閉塞して激しい月経痛や排便痛、慢性骨盤痛を引き起こす。その手術において、不用意な剥離操作は尿管・直腸損傷のリスクを高めるが、不十分な開放では症状の改善は望めない。今回、腹腔鏡下手術でのダグラス窩開放時に著者等が行っている工夫を紹介し、これまでに施行した10例の成績を報告した。ダグラス窩開放の際に留意すべきは尿管・腸管損傷であり、そのさい尿管の同定を直腸側腔まで行うことにより、尿管を視認しながらダグラス窩病変に手術操作を加えることが可能となる。著者等が行っているダグラス窩開放の手順は、子宮マニピュレーターで子宮を挙上させたのち、腟から挿入した自在鈎で後腟円蓋を十分に膨隆させる。これにより、剥離すべき部位が明らかになる。

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Language：Japanese   Publisher：金原出版(株)  

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Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(株)診断と治療社  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本エンドメトリオーシス学会  

子宮内膜症症例を検討し、再発のリスク、術後の薬物療法の再発防止効果について検討した。子宮内膜症の手術を施行し、追跡可能であった167例を対象とした。36例で再発を認めた。ReASRMスコアは、再発群で高い傾向がみられた。手術時の年齢は、有意に再発群で若かった。術後に薬物療法を施行しなかった群では、21%に再発を認めた。GnRHa使用群では、6ヵ月の使用中は再発を認めなかったが、使用終了後に45.5%で再発を認めた。低用量ピルおよびジェノゲストは継続服用しているものに関しては、再発を認めなかった。しかし除外対象とした症例において、低用量ピルを術後より使用開始したものの何らかの理由により途中中断したものが9例あり、そのうち5例で再発を認めた。再発の有無にかかわらず、約50%の妊娠率を認めた。

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本生殖免疫学会  

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Language：Japanese   Publisher：(株)診断と治療社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00525&link_issn=&doc_id=20090403240040&doc_link_id=%2Fae4sanke%2F2009%2F0076s1%2F040%2F0272-0278%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4sanke%2F2009%2F0076s1%2F040%2F0272-0278%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

ポリープ状異型腺筋腫は主として子宮下部に発生する稀なポリープ様病変である。組織学的には良性腫瘍に分類される。しかし、一部に子宮体癌との共存例が報告されている。当科にてポリープ状異型腺筋腫の発生茎部付近の子宮内膜に癌の合併を確認できた症例を経験した。症例は1回経産、近医にて子宮内膜細胞診クラスIIIを指摘され、紹介となった。子宮内膜全面掻爬にてポリープ状異型腺筋腫と診断し、経過観察となった。9ヵ月後、子宮内にポリープ状腫瘤が再度出現した。低悪性度ポリープ状異型腺筋腫と子宮体癌0期の混在との病理診断であった。このようにポリープ状異型腺筋腫は子宮体癌との共存例があることに留意する必要がある。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)東京産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：English   Publisher：University of Tokyo Press  

DOI： 10.1111/j.1447-0756.2000.tb01199.x

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