子宮内膜症と妊孕性に関する内視鏡学的研究 (<シンポジウム>子宮内膜症をめぐる諸問題)

NDLデジタルコレクション 被引用文献3件
  • 星合,昊
    東北大学医学部産科学婦人科学教室

書誌事項

タイトル別名
  • Laparoscopic Studies for Pelvic Endometriosis in Relation to Sterility

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Six hundred and eighteen endometriosis patients out of 2,966 cases diagnosed with laparoscopy were statistically analyzed. The incidence of pelvic endometriosis was 28.3% of infertile cases, 47.2% of infertile cases of etiology unknown sterility, and 53.6% of cases of dysmenorrhea. Initial onset was most common in the sacrouterine ligament and the pouch of Douglas, followed by the ovaries. It was also seen in the vesicouterine pouch. The progress after the initial onset was considered to be due mainly to ovarian lesions, and the progressive rate appeared to be 0.3 point per month according to the R-AFS point system. Cases with stage 3 ovarian lesions were seen up to 7 years after menarche, and there were almost no cases of endometriosis 10 years after menopause. No differences in the average age were seen by stage of clinical progress or R-AFS, and the average age was around 31. The period of infertility showed no definite relation with the stage of the disease in cases of primary sterility, but stage 1 cases were common in patients with secondary sterility. The incidence of dysmenorrhea did not differ depending on the stage of the disease, but severe menstrual pain was common in stage 4 cases. The frequency associated with sterility did not differ in accordance with the stage. Severe pain at the time of endoscopy and induration of Douoglas' pouch were common in stage 4 cases, but 31.9% of stage 4 cases showed no abnormal findings in pelvic examination. There was no significant difference between R-AFS points and the incidence of abnormal findings in HSG. Abnormal laparoscopic findings were found in 40% of cases with no abnormal findings in HSG, while abnormal HSG findings were seen in 65.1% of cases with no abnormalities in laparoscopic findings. The false positive frequency for CA12-5 was extremely low, but false negative results were often seen in stage 1 and 2. In distinguishing between ovarian malignant tumors and endometrio sis, SLX appeared to be useful in CA12-5 positive cases. As the clinical stage of the disease advanced, there was an increase in the number of positive items with respect to synptoms and the diagnostic methods, but 11.1% of cases in stage 4 had no symptoms or abnormal findings other than infertility. Therapeutic results: When CA12-5 was used as the marker during drug treatment, it decreased and entered the normal range for all drugs, but the pattern of serum estradiol reduction differed depending on the drug. When Danazol and LH-RH agonist depo were used concomitantly, the peak value was significantly lower than that when LH-RH agonist was administered alone, and there was a decrease thereafter to 20～30pg/ml or less. When the effects of drug treatment were examined endoscopically, the R-AFS scores were -4.7/month for Danazol, -2.7/month for LH-RH agonist depo. When the effects of Danazol were evaluated by R-AFS points before and after administration, the average rate of imporvement was 53%, and the rate of improvement was significantly different for the peritoneal lesions in particular. Pregnancy rate: None of the patients 37 or older, or infertile for 11 years or longer become pregnant. Among the patient with no factors other than endometriosis, the pregnancy rate was the lowest, 28.1%, for stage 1, and was 42.1% for stage 2, 36.4% for stage 3 and 47.8% for stage 4. In cases with only laparoscopy, the pregnancy rate was 31.8%, that for cases given drug treatment was 38.9%, that for patients undergoing operations was 75% and that for cases of both drug treatment and operations was 25%. Among six stage 4 cases with only laparoscopy, three became pregnant. In pregnant cases in stage 3 or 4 and these with only laparoscopy, the following point was common to both. There was no adhesion to a unilateral oviduct and no adhesion to the ovary on the side with the low adnexa score.

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