著者

山下 優 奥村 能城 井村 友紀 奥田 知宏

出版者

一般社団法人 日本周産期・新生児医学会

雑誌

日本周産期・新生児医学会雑誌 (ISSN:1348964X)

巻号頁・発行日

vol.56, no.2, pp.309-314, 2020 (Released:2020-09-10)

参考文献数

11

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災害発生時は衣食住資源と共に医療資源確保も困難となる.今回我々は集中豪雨による河川増水・土砂崩れの影響で孤立した療養型病院でテレビ通話を使用し正常分娩に至った症例を経験した.29歳女性,2妊1産,自然妊娠で当院通院中であった.妊娠40週に陣痛発来あるが豪雨による冠水・土砂崩れにより来院不可であり自宅近くの当院分院を受診.分院には内科医・看護師のみで,産科・小児科・助産師不在であった.陸空路移送は不可能であり,本院からテレビ電話を使用し分娩状況を確認.分娩指示を行い経腟分娩に至った.児は2,900gでApgar score 9/10点の男児であった.胎盤もテレビ電話でBrandt法を指示し剥離を施行した.産後1日目に道路開通し本院搬送となるが母児共に経過良好で,産後4日目に軽快退院となった.災害時の医療資源確保は困難だがデバイスを駆使することや周産期教育推進で医療連携が取れ資源確保ができる可能性が示唆された.

著者

奥田 知宏 吉岡 崇 秋山 誠 山下 貞雄

出版者

Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy

雑誌

日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)

巻号頁・発行日

vol.26, no.2, pp.429-434, 2010 (Released:2011-06-02)

参考文献数

17

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Laparoscopic surgery is a valuable tool in the definitive diagnosis and treatment of benign uterine tumors. Here we report two cases diagnosed as benign uterine tumors by laparoscopic surgery: the first is an adenomatoid tumor that was suspected preoperatively as a uterine leiomyoma; the second is a uterine leiomyoma that was suspected preoperatively as an adenomatoid tumor.Cases:   Case 1: A 63 year-old woman presented to our hospital complaining of lumbago. Uterine myoma was suspected and ultrasound and MRI were performed. A cystic uterine tumor suggesting benign uterine leiomyoma was discovered. However, malignancy could not be ruled out, therefore, the patient consented to LAVH (laparoscopic assisted vaginal hysterectomy). Upon removal of the patient's uterus, macroscopic examination of the tumor was strongly suggestive of uterine leiomyoma. The specimen was sent to pathology; microscopic examination and immunohistological testing provided the definitive diagnosis of benign adenomatoid tumor.   Case 2: A 44 year-old woman presented to our hospital for periodic examination of a uterine myoma that she had been diagnosed with several years ago. MRI was performed and myoma nodule was found. To rule out malignancy, a diagnostic and therapeutic laparoscopic assisted myomectomy (LAM) was recommended. LAM was chosen because the tumor surface appeared as a usual myoma nodule. Final pathology findings on immunohistochemical study of the surgical specimen confirmed the diagnosis of uterine leiomyoma.Conclusion:   Laparoscopic surgery provides many advantages in clinical gynecological practice. We stress the importance of laparoscopic surgery in preventing misdiagnosis, and in providing definitive diagnosis and treatment in cases of benign gynecologic tumors, including the rare uterine adenomatoid tumor presented herein. We recommend laparoscopic surgical intervention particularly in cases where various imaging studies including MRI, CT, and sonogram, are incompatible with or unable to confirm benign tumor origin.