Asano Ryoko, Nakazawa Tsuneo, Hirahara Fumiki, Sakakibara Hideya
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):1110-2. doi: 10.1016/j.jmig.2014.04.014. Epub 2014 Apr 26.
Hemorrhagic ascites caused by endometriosis is extremely rare, and its treatment is under discussion. We report a case of recurrent endometriosis-related ascites treated with dienogest (DNG). A 35-year-old nulliparous Japanese woman with a history of infertility presented with worsening dysmenorrhea and abdominal distention caused by massive ascites. The patient underwent exploratory laparotomy, and hemorrhagic ascites (5500 mL) was drained. She had a normal-sized uterus, and the bilateral ovaries could not be observed because of extensive adhesion in the abdominal cavity. Endometriosis was diagnosed by histopathological evaluation of the omental biopsy, and this was considered to be the cause of ascites. After laparotomy, she had recurrence of ascites. For the next 8 years, the patient was treated conservatively with gonadotropin-releasing hormone agonist therapy and drainage during the intermittent periods followed by DNG administration. She has been treated continuously with DNG for 1 year with no recurrence of ascites. DNG could be an effective treatment for recurrent ascites associated with endometriosis, especially when surgical therapy is undesirable.
子宫内膜异位症引起的出血性腹水极为罕见，其治疗方法仍在讨论中。我们报告一例用地诺孕素（DNG）治疗复发性子宫内膜异位症相关腹水的病例。一名35岁未生育的日本女性，有不孕史，因大量腹水导致痛经加重和腹胀前来就诊。患者接受了剖腹探查术，引流出5500毫升出血性腹水。她的子宫大小正常，由于腹腔广泛粘连，双侧卵巢无法观察到。通过大网膜活检的组织病理学评估诊断为子宫内膜异位症，认为这是腹水的原因。剖腹手术后，她出现了腹水复发。在接下来的8年里，患者在间歇期接受促性腺激素释放激素激动剂治疗和引流，随后给予DNG治疗。她接受DNG持续治疗1年，腹水未复发。DNG可能是治疗与子宫内膜异位症相关的复发性腹水的有效方法，尤其是在手术治疗不可取的情况下。
