{"created":"2023-05-15T11:21:21.284369+00:00","id":25,"links":{},"metadata":{"_buckets":{"deposit":"35ef6ac9-e32c-44dc-91d9-bff9812c8b30"},"_deposit":{"created_by":1,"id":"25","owners":[1],"pid":{"revision_id":0,"type":"depid","value":"25"},"status":"published"},"_oai":{"id":"oai:showa.repo.nii.ac.jp:00000025","sets":["1:6:7:8"]},"author_link":["68","73","72","74","78","76","69","80","77","71","65","64","79","66","67","70","75"],"item_10002_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-08"},"bibliographicIssueNumber":"4","bibliographicPageEnd":"377","bibliographicPageStart":"372","bibliographicVolumeNumber":"78","bibliographic_titles":[{"bibliographic_title":"昭和学士会雑誌"}]}]},"item_10002_description_6":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"存続絨毛症はあらゆる妊娠の終了後に起こり得る疾患である．今回，異所性妊娠終了後に血中hCGの再上昇を認め，存続絨毛症の診断に至った症例を経験したので報告する．症例は35歳女性，1妊1産．下腹部痛を主訴に受診した．妊娠反応陽性，最終月経より妊娠6週であるが，経腟超音波検査では子宮内に明らかな胎嚢を認めず，右付属器領域に不整形の胎嚢様腫瘤とDouglas窩に腹腔内出血を示唆するecho free spaceを認めた．血中hCG値は13,453mIU/mlであった．異所性妊娠破裂の疑いと診断し試験開腹術を施行した．右卵管角より活動性出血を認め，右卵管角の楔状切除，右卵管切除術を施行した．術中肉眼所見，病理学的所見より腹膜妊娠の破裂と診断した．絨毛成分を認めたが胞状奇胎は認めなかった．血中hCG値は術後5日目に568mIU/mlまで低下した．経過良好にて退院した．術後3週間目の検診時，血中hCG値は3,093mIU/mlと再上昇しており，絨毛性疾患の続発症を疑い造影MRI・CTにより全身を検索した．画像上明らかな病巣は確認できなかった．存続絨毛症と診断し，MTX療法（20mg/day，5日間筋注）により治療した．合計4コース施行後に血中hCG値はcut off値以下となった．以後，現在まで順調な経過をたどっている．存続絨毛症は，先行妊娠が胞状奇胎の場合には，管理指針に則りhCGの再上昇から診断できるが，非胞状奇胎妊娠の場合にはその発症を疑うことは容易ではない．本症例では，組織学的に胎芽成分の一部を認めており全胞状奇胎は否定されたが，部分胞状奇胎と正常妊娠の判別を行うためにマイクロサテライトマーカーを用いたDNA多型解析を施行した．その結果，正常2倍体妊娠であると推定された．一般に流産後の管理において，hCGを測定するか否かの指針はない．存続絨毛症発症の可能性を念頭に置き，少なくとも異常妊娠後は血中hCG値が陰性化するまでフォローすることが異常の早期発見につながると考えられた．","subitem_description_type":"Abstract"}]},"item_10002_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"昭和大学学士会"}]},"item_10002_relation_14":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"10.14930/jshowaunivsoc.78.372"}}]},"item_10002_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"2187-719X"}]},"item_10002_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"吉泉, 絵理"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"佐々木, 康"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"濱田, 尚子"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"岡田, あかね"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"丸山, 大介"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"竹中, 慎"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"中林, 裕貴"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"福谷, 梨穂"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"村元, 勤"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"岡崎, 美寿歩"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"山下, 有加"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"中山, 健"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"森岡, 幹"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"小川, 公一"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"磯邊, 友秀"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"大池, 信之"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"九島, 巳樹"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-07-26"}],"displaytype":"detail","filename":"78_372.pdf","filesize":[{"value":"814.1 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"78_372.pdf","url":"https://showa.repo.nii.ac.jp/record/25/files/78_372.pdf"},"version_id":"6e23c9b6-ff4a-44da-83b3-f594ad085aff"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper"}]},"item_title":"異所性妊娠後に発症した存続絨毛症の1例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"異所性妊娠後に発症した存続絨毛症の1例"}]},"item_type_id":"10002","owner":"1","path":["8"],"pubdate":{"attribute_name":"公開日","attribute_value":"2018-12-12"},"publish_date":"2018-12-12","publish_status":"0","recid":"25","relation_version_is_last":true,"title":["異所性妊娠後に発症した存続絨毛症の1例"],"weko_creator_id":"1","weko_shared_id":-1},"updated":"2023-05-15T13:14:01.698923+00:00"}