福元 裕貴¹, 西村 和朗^{1, 2}, 金城 泰幸¹, 星野 香¹, 原田 大史¹, 近藤 恵美¹, 植田 多恵子¹, 栗田 智子¹, 松浦 祐介³, 吉野 潔¹

Yuki FUKUMOTO¹, Kazuaki NISHIMURA^{1, 2}, Yasuyuki KINJO¹, Kaori HOSHINO¹, Hiroshi HARADA¹, Emi KONDO¹, Taeko UEDA¹, Tomoko KURITA¹, Yusuke MATSUURA³, Kiyoshi YOSHINO¹

¹産業医科大学産科婦人科, ²九州労災病院産婦人科, ³産業医科大学産業保健学部広域・発達看護学

¹Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, ²Kyushu Rosai Hospital, ³Nursing of Human Broad Development, University of Occupational and Environmental Health

キーワード : laparoscopic ultrasonography, paraurethral leiomyoma, vaginal leiomyoma

今回我々は，術中に腹腔鏡用超音波検査を使用することで稀な傍尿道腫瘍と判断し治療した症例を経験したので報告する．症例は39歳女性，4経妊1経産，当科を受診する約1年前より頻尿を自覚していた．検診にて膀胱を圧排する骨盤内腫瘍を指摘され，精査加療目的に当科を紹介受診した．経腟超音波断層法検査とMRI検査で前腟壁内の尿道直下に直径約5 cm大の境界明瞭な腫瘤を認めた．頻尿の症状があり，腫瘍は増大傾向であるため摘出する方針とした．膀胱や尿道にも近接するため腹腔鏡補助下に腫瘍を摘出する方針とした．腹腔鏡下に腟壁から尿道付近まで前腟と膀胱とを剥離したが，腫瘍と腟壁に連続性がなく，術中に施行した腹腔鏡用超音波検査で剥離した膀胱周囲組織内に腫瘍が存在していた．腟由来ではなく傍尿道腫瘍であると判断し，尿道周囲操作が可能な経腟アプローチに切り替え腫瘍摘出に至った．病理組織検査では平滑筋腫であり悪性所見はなかった．今回の症例は術中に施行した腹腔鏡用超音波検査により傍尿道腫瘍と診断できた．腹腔鏡用超音波検査は腹腔内を観察するだけでなく比較的稀とされる腟内や傍尿道，膀胱周囲に存在する腫瘍同定にも有用である．

There are limited reports on the use of laparoscopic ultrasonography in gynecological surgery. We describe a case in which intraoperative laparoscopic ultrasonography was used to identify and treat a rare paraurethral tumor. A 39-year-old woman with four previous pregnancies and one delivery had frequent urination for approximately 1 year prior to her visit to our department. Transvaginal ultrasonography and MRI showed a well-defined mass of approximately 5 cm in diameter just below the urethra in the anterior vaginal wall. The patient had frequent urination, and the tumor seemed to have increased in size. Hence, we decided to remove it. Our preoperative diagnosis was a vaginal leiomyoma in the anterior vaginal wall, which was to be removed with laparoscopic assistance due to its proximity to the bladder and urethra. Laparoscopically, the anterior vaginal wall and bladder were dissected from the vaginal wall to near the urethra. However, there was no continuity between the tumor and vaginal wall. Furthermore, intraoperative laparoscopic ultrasonography revealed that the tumor was in the dissected peri-bladder tissue. We determined that this was a paraurethral tumor, not a vaginal tumor, and switched to a transvaginal approach that allowed periurethral manipulation, which led to the removal of the tumor. Histopathological examination revealed a leiomyoma with no malignant findings. Intraoperative laparoscopic ultrasonography allowed us to diagnose the pararectal tumor. Hence, laparoscopic ultrasonography is useful for observing the intra-abdominal cavity and identifying tumors in the vaginal, paraurethral, and periurethral areas, which are considered to be relatively rare.