{"created":"2023-05-15T11:24:26.127026+00:00","id":4204,"links":{},"metadata":{"_buckets":{"deposit":"84be934b-7d83-4ad8-97ee-82b79cf5c2f7"},"_deposit":{"created_by":1,"id":"4204","owners":[1],"pid":{"revision_id":0,"type":"depid","value":"4204"},"status":"published"},"_oai":{"id":"oai:showa.repo.nii.ac.jp:00004204","sets":["1:6:353:379"]},"author_link":["14065","14067","14069","14064","14070","14071","14068","14063","14066","14072"],"item_10002_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2022-11","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"5","bibliographicPageEnd":"394","bibliographicPageStart":"388","bibliographicVolumeNumber":"82","bibliographic_titles":[{"bibliographic_title":"昭和学士会雑誌"}]}]},"item_10002_description_6":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"胎盤遺残の手術加療において明確な治療指針はない．今回胎盤付着部の筋層菲薄化，胎盤への血流の有無で術式を選択する治療指針案の妥当性を検討した．2015年12月から2020年12月に当院でMRI検査を行い，胎盤遺残の診断で手術を施行した症例を対象とし，指針案に基づいた「想定術式」と実際に施行された術式との比較検討を後方視的に行った．指針案による術式決定基準として，菲薄化陽性（厚さ＜5mm）例では血流に関わらず腹腔鏡併用TCR （Trans Cervical Resection），菲薄化陰性で血流あり症例は腹腔鏡非併用TCR（以降，TCR），共にない症例はD&C （Dilation and curettage）を選択した．調査期間内に対象症例は12例であった．予定術式は腹腔鏡併用TCR 1例，TCR 8例，D&C 3例，うち10例は完遂したが，残り2例で術式変更を要し，1例はTCRで子宮穿孔し腹腔鏡手術へ移行，1例はD&Cで摘出困難なためTCRへ移行した．指針案に基づく想定術式による分類は腹腔鏡併用TCR 1例，TCR 7例，D&C 4例であった．実際の施行術式と同一だったのは9/12例，相違のあった3例中，D&C想定の2例は主治医判断でTCRを選択し，施行術式もTCRであった．想定術式がTCRの1例では，子宮穿孔により腹腔鏡手術に移行した．穿孔の要因として双角子宮，胎盤卵管角周囲付着，術中盲目的操作が考えられた．子宮奇形や付着部位異常例は穿孔リスクが高いとされるため，指針案を一部改良した．今回われわれが提唱した治療指針案は，検討の結果実際の施行術式や転帰に矛盾せず，概ね適正であったと考える．今後は指針案が適切に運用可能かを前向きに検証していく．","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":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"10.14930/jshowaunivsoc.82.388","subitem_relation_type_select":"DOI"}}]},"item_10002_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"2188-529X","subitem_source_identifier_type":"ISSN"}]},"item_10002_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"吉泉, 絵理"}],"nameIdentifiers":[{"nameIdentifier":"14063","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"三村, 貴志"}],"nameIdentifiers":[{"nameIdentifier":"14064","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"小林, 友紀"}],"nameIdentifiers":[{"nameIdentifier":"14065","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"河本, 貴之"}],"nameIdentifiers":[{"nameIdentifier":"14066","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"長島, 稔"}],"nameIdentifiers":[{"nameIdentifier":"14067","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"宮上, 哲"}],"nameIdentifiers":[{"nameIdentifier":"14068","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"石川, 哲也"}],"nameIdentifiers":[{"nameIdentifier":"14069","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"小貫, 麻美子"}],"nameIdentifiers":[{"nameIdentifier":"14070","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"関沢, 明彦"}],"nameIdentifiers":[{"nameIdentifier":"14071","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"松本, 光司"}],"nameIdentifiers":[{"nameIdentifier":"14072","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2023-04-07"}],"displaytype":"detail","filename":"82_388.pdf","filesize":[{"value":"715.6 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"82_388.pdf","url":"https://showa.repo.nii.ac.jp/record/4204/files/82_388.pdf"},"version_id":"cf4e906f-1eab-4ff3-857b-ddf156d70db0"}]},"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","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"胎盤遺残症例に対する鏡視下手術の適応についての検討","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"胎盤遺残症例に対する鏡視下手術の適応についての検討"}]},"item_type_id":"10002","owner":"1","path":["379"],"pubdate":{"attribute_name":"公開日","attribute_value":"2023-04-07"},"publish_date":"2023-04-07","publish_status":"0","recid":"4204","relation_version_is_last":true,"title":["胎盤遺残症例に対する鏡視下手術の適応についての検討"],"weko_creator_id":"1","weko_shared_id":-1},"updated":"2023-05-15T11:38:34.134415+00:00"}