{"created":"2023-06-20T15:48:30.540679+00:00","id":3026,"links":{},"metadata":{"_buckets":{"deposit":"5a71a2fe-dae5-4b70-901e-b4b4d5d0dfb4"},"_deposit":{"created_by":4,"id":"3026","owners":[4],"pid":{"revision_id":0,"type":"depid","value":"3026"},"status":"published"},"_oai":{"id":"oai:hama-med.repo.nii.ac.jp:00003026","sets":["1:12:59"]},"author_link":["8982","8983","8984","8985"],"control_number":"3026","item_3_biblio_info_5":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2017-04","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"66","bibliographicPageStart":"60","bibliographicVolumeNumber":"6","bibliographic_titles":[{"bibliographic_title":"静岡産科婦人科学会雑誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Journal of the Shizuoka Society of Obstetrics and Gynecology","bibliographic_titleLang":"en"}]}]},"item_3_description_9":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"子宮頸部筋腫は、子宮頸部が腫大することで子宮動脈や尿管の解剖学的変位をきたすことが多く、また切開すべき腟上端が不明瞭となるため、その子宮全摘術は操作に難渋することが多い。今回、子宮頸部左側に発生する子宮頸部筋腫に対して腹腔鏡下子宮全摘術を施行した症例を初めて経験し、事前に立てたストラテジーとの相違点から学んだことを検討、考察したため報告する。\n症例は48歳、4経妊3経産（初期流産1回、経腟分娩3回）。2年前からの不正出血と Hb9.1g/dl の貧血のため前医より手術目的で紹介となった。経腟診察で外子宮口が2cmほど開大しており、頸管内に筋腫が確認できる状態であった。MRIでは筋腫分娩ではなく、頸管左側から内腔に発育した8cmの子宮頸部筋腫と考えられた。術前にGnRHアゴニスト（点鼻薬）を投与し、術直前に尿管ステントを挿入。経腟的に自在鈎（スパーテル®）を挿入して腟上端 切開部の挙上を試みる方針で腹腔鏡下子宮全摘術を施行した。手術時間は3時間42分、出血量は 200g、検体重量は 484gであった。結果、子宮頸部筋腫の発生する左側では、経腟的に自在鈎で腟上端切開部を挙上しても腹腔内からの同定は困難であった。経腟的に挿入した自在鈎が偶発的に外子宮口から頸管内に挿入され内子宮口筋層 にテンションをかける状態となり、先に腟上部切断術を施行し、頸部筋腫を核出してから、残存頸部を摘出して経腟的に搬出した。自己血 400ml を返血し、合併症なく退院された。\n子宮動脈本幹処理と尿管ステント挿入は術前のストラテジー通り有効であったが、経腟的に自在鈎を挿入して腟上端切開部を同定することは無効であり、 挿入部位を誤認する可能性を念頭に入れ注意する必要があると考えられた。","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_3_publisher_6":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"静岡産科婦人科学会","subitem_publisher_language":"ja"}]},"item_3_relation_27":{"attribute_name":"医中誌論文ID","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"2017342600","subitem_relation_type_select":"ICHUSHI"}}]},"item_3_source_id_20":{"attribute_name":"EISSN","attribute_value_mlt":[{"subitem_source_identifier":"2187-1914","subitem_source_identifier_type":"EISSN"}]},"item_3_version_type_32":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"望月, 亜矢子","creatorNameLang":"ja"},{"creatorName":"MOCHIZUKI, Ayako","creatorNameLang":"en"}],"nameIdentifiers":[{"nameIdentifier":"8982","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"飯田, 智子","creatorNameLang":"ja"},{"creatorName":"IIDA, Tomoko","creatorNameLang":"en"}],"nameIdentifiers":[{"nameIdentifier":"8983","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"川西, 智子","creatorNameLang":"ja"},{"creatorName":"KAWANISHI, Tomoko","creatorNameLang":"en"}],"nameIdentifiers":[{"nameIdentifier":"8984","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"平井, 強","creatorNameLang":"ja"},{"creatorName":"HIRAI, Tsuyoshi","creatorNameLang":"en"}],"nameIdentifiers":[{"nameIdentifier":"8985","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2018-08-27"}],"displaytype":"detail","filename":"jsog-6-1-60.pdf","filesize":[{"value":"752.5 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"jsog-6-1-60.pdf","objectType":"fulltext","url":"https://hama-med.repo.nii.ac.jp/record/3026/files/jsog-6-1-60.pdf"},"version_id":"15e5ed80-69ed-4647-bfdc-4e2d6b3460dd"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"cervical leiomyoma","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"total laparoscopic hysterectomy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"ureteric catheter","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"子宮頸部筋腫に対する腹腔鏡下子宮全摘術の初期経験","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"子宮頸部筋腫に対する腹腔鏡下子宮全摘術の初期経験","subitem_title_language":"ja"},{"subitem_title":"Initial experience of total laparoscopic hysterectomy for cervical leiomyoma: a case report","subitem_title_language":"en"}]},"item_type_id":"3","owner":"4","path":["59"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2017-04-27"},"publish_date":"2017-04-27","publish_status":"0","recid":"3026","relation_version_is_last":true,"title":["子宮頸部筋腫に対する腹腔鏡下子宮全摘術の初期経験"],"weko_creator_id":"4","weko_shared_id":-1},"updated":"2024-07-30T04:31:49.332067+00:00"}