Japanese

Title	ホルモン療法中に再発した月経随伴性気胸の1例
Subtitle	研究 症例報告
Authors	菊池香織1), 八田幸治1), 高山敬範1), 潮田至央1), 佐伯典厚1), 城光寺龍2), 橋本奈美子1)
Authors (kana)
Organization	1)日本生命病院産婦人科, 2)病理診断科
Journal	産婦人科の進歩
Volume	73
Number	3
Page	295-300
Year/Month	2021 / 8
Article	報告
Publisher	近畿産科婦人科学会
Abstract	「概要」月経随伴性気胸 (catamenial pneumothorax ; CP) は胸腔内子宮内膜症に分類され, 月経期に関連した気胸であり, 近年稀少部位子宮内膜症の1つと考えられている. 一般的に手術療法とホルモン療法を組み合わせて治療するが, 再発率は高い. 今回われわれは, 術後ホルモン療法中に再発したCPの症例を経験したので報告する. 症例は41歳, G0, 既往歴としてX-2年前より右側気胸を繰り返し, 他院にて保存的加療中であった. X年に胸痛および呼吸困難感あり, 当院救急外来受診し右側気胸と診断, 月経期に一致しておりCPの疑いにて当科紹介となった. 明らかな両側付属器腫大は認めなかったが, 骨盤単純MRI検査にて子宮内膜症を強く疑う高度な骨盤内癒着を認めたため, 子宮内膜症の治療に準じdienogestを開始した. 内服開始3カ月後に右側気胸の再発を認めたが, 経過観察のみで改善した. さらに2カ月後, 縦隔偏位を伴う高度右側気胸を認めたため再発性気胸の診断にて胸腔鏡下右横隔膜切除縫縮術の方針となった. 胸腔鏡下に観察すると横隔膜は菲薄化し7cmにわたり3〜5mmのスリット状欠損孔を多数認め, 一部では下面に肝表面が確認できた. 病理組織診断では明らかな子宮内膜組織は確認できなかった. 術後にdienogestを再開したが3カ月後に右側気胸の再発を認めたため, 胸膜癒着術を施行した. 術後はGnRH-agonistを6カ月投与後にdienogestを再開し現在まで再発は認めていない. 従来, CPでは術後再発予防のためにGnRH-agonistもしくはOC/LEPが使用されることが一般的であったが長期服用の必要性と血栓症のリスクから, 子宮内膜症の治療に準じdienogestの使用が検討されつつある. CPは術後のホルモン療法の有無にかかわらず再発率が高いことが知られており, 長期にわたり慎重に経過観察を続けていくことが大切である.
Practice	臨床医学：外科系
Keywords	胸腔子宮内膜症性気胸, 月経随伴性気胸, ホルモン療法, catamenial pneumothorax, thoracic endometriosis syndrome, hormone therapy

English

Title	A case of catamenial pneumothorax with recurrence during hormone therapy
Subtitle	CASE REPORT
Authors	Kaori KIKUCHI1), Koji HATTA1), Takanori TAKAYAMA1), Norichika USHIODA1), Noriatsu SAEKI1), Ryu JOKOJI2), Namiko HASHIMOTO1)
Authors (kana)
Organization	1)Department of Obstetrics and Gynecology, Nippon Life Hospital, 2)Department of Pathology, Nippon Life Hospital
Journal	Advances In Obstetrics And Gynecology
Volume	73
Number	3
Page	295-300
Year/Month	2021 / 8
Article	Report
Publisher	The Obstetrical Gynecological Society of Kinki District Japan
Abstract	[Abstract] Catamenial pneumothorax (CP) is classified as a thoracic endometriosis syndrome that develops during menstruation. However, some cases of pneumothorax can develop at other times as well. We experienced a case of CP with repeated recurrence during hormone therapy. The patient was a 41-year-old nulliparous woman with a two-year history of pneumothorax recurrence. She presented to the emergency department and was diagnosed with right pneumothorax. Based on her medical history, she was suspected to have CP and was referred to the Obstetrics and Gynecology Department. Although magnetic resonance imaging did not reveal the presence of an endometriotic cyst, signs of pelvic adhesion were noted. Endometriosis was strongly suspected. Therefore, dienogest was prescribed for managing the endometriosis. However, her CP recurred despite hormone therapy ; thus, we performed a surgery under thoracoscopy. A thinning lesion was observed in the diaphragm and a part of the right diaphragm was removed. Although the patient received hormone therapy, the pneumothorax recurred three months after surgery. Chest drainage was performed as conservative therapy ; however, her symptoms did not resolve. Therefore, pleurodesis was performed. Simultaneously, we switched the patient to a GnRH-agonist regimen followed by dienogest. She remains free of recurrence at one year eight months.
Practice	Clinical surgery
Keywords	catamenial pneumothorax, thoracic endometriosis syndrome, hormone therapy

• 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。

参考文献