当科における子宮内膜症に対する腹腔鏡下保存手術 : 不妊症合併症例に対する役割の再検討と疼痛軽減のための術式の工夫

Endometriosis is a common gynecological disease which causes dysmenorrhea,discomfort during defecation and painful intercourse and is closely related to infertility. The purpose of this study is to confirm the value of laparoscopic conservative surgery for endometriosis complicated by infertility and to introduce original methods to decrease the symptoms arising from endometriosis in our department. Between 2001 and 2003,22 patients with endometriosis complicated by infertility were treated by laparoscopic surgery. Seven patients (31.8%) conceived naturally within 6 months after surgery. One patient (4.5%) conceived by artificial insemination (AIH)and 3 (13.6%)got pregnant by in vitro fertilization-embryo transfer (IVF-ET). Since our success rate at IVF-ET in 2003 was 20.8%, laparoscopic surgery is considered to be useful for endometriosis patients complicated by infertility. Endometriosis consists of lesions such as ovarian tumor, peritoneal lesion and deep infiltrating lesion. Recently, besides ovarian cystectomy, adhesiolysis and laparoscopy-assisted uterosacral nerve ablation (LUNA), we attempted to perform other two methods for symptoms caused by endometriosis. One is the incision of constricted peritoneum to repair an inflective uterus and narrow cul-de-sac.The other is removal of deep infiltrated indurations located in the rectovaginal septum. Although the long-term prognosis is uncertain,we were able to decrease the symptoms arising from endometriosis.