湾曲した子宮内膜アブレーション用マイクロ波アプリケーターの開発(<特集>第56回日本産科婦人科学会シンポジウム4 : 安全性および確実性の向上を目指した婦人科手術の工夫)

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Endometrial ablation is a technique for destroying the endometrium in situ as an alternative to hysterectomy for menorrhagia resistant to conservative therapy. However, none of the ablative techniques developed over the last two decades are useful for treatment of organic menorrhagia in a uterus enlarged with a distorted cavity. The authors have developed a curved microwave applicator applicable to an enlarged uterus with a distorted uterine cavity more than 12cm in length ; a situation that had been a contraindication for conventional endometrial ablation. The curved microwave applicator radiates microwaves at a frequency of 2.45 GHz, heats the uterine tissue, and necrotizes the endometrium and adjacent myometrium. In animal experiments, the applicator was inserted into swine hepatic tissue and microwaves radiated. The size of necrotized area was visualized in the enzyme activity of succinate dehydrogenase using an enzyme chemical method by adding nitroblue tetrazolium and sodium succinate. Fresh surgical specimens of uteri with myomas or adenomyosis were irradiated by microwaves guided through the applicator introduced into the enlarged uterine cavity. The size of the necrotized area was visualized by enzyme chemistry. To analyze temperature distribution around the applicator tip , computer simulation was undertaken using commercially available software for calculating an electromagnetic field and thermal flow. Temperature distributions by computer simulation fully described the area of necrosis in the experiments. From this, a microwave output of 40W and duration of 50 seconds for each irradiation site were selected as the irradiation conditions for clinical application. Ten patients with organic menorrhagia with an enlarged distorted uterine cavity underwent MEA. Menorrhagia was improved in all patients and no major complication was encountered. We concluded that MEA using our curved microwave applicator could safely treat organic menorrhagia in an enlarged uterus with a distorted cavity.
社団法人日本産科婦人科学会の論文
2004-12-01

湾曲した子宮内膜アブレーション用マイクロ波アプリケーターの開発(<特集>第56回日本産科婦人科学会シンポジウム4 : 安全性および確実性の向上を目指した婦人科手術の工夫)

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