機能性子宮を有する子宮頸管閉鎖・上部腟欠損の治療に腹腔鏡・子宮鏡下手術の併用が有用であった一例

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A 14-year-old girl experienced lower abdominal pain of one weeks duration that recurred monthly for the past year. Her family physician suspected menstrual molimina and referred her to our facility. On pelvic examination, the vagina was 7 cm long and ended blindly; a cervix was not visible. Transrectal ultrasound and magnetic resonance imaging revealed fluid accumulation at sites thought to be the endometrial cavity and cervix. Menstrual molimina due to a transverse vaginal septum or cervical atresia and partial vaginal aplasia was suspected. Laparoscopic evaluation revealed a symmetrical uterine corpus with a normal appearance. A vaginal incision was made with a scalpel, however, a stoma could not be created. During laparoscopy, the fundus was incised by electrocautery, a uterine probe was inserted, and an incision was made from the vaginal side of the probe tip in an attempt to create a stoma. Due to limited tissue distensibility, suturing the vaginal wall and cervix was difficult. Therefore, we created a stoma under hysteroscopy. Menstrual flow promptly occurred after creation of the stoma. At her 6-month follow-up exam she reported that her menses were regular and not accompanied by severe dysmenorrhea. The stoma has remained functional. For cases of cervicovaginal atresia, a combined laparoscopic and hysteroscopic procedure can resolve the condition.
日本産科婦人科内視鏡学会の論文