{"created":"2023-05-25T05:26:19.713750+00:00","id":5106,"links":{},"metadata":{"_buckets":{"deposit":"02821df0-7fda-417a-8411-0f681b72fb78"},"_deposit":{"created_by":17,"id":"5106","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"5106"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00005106","sets":["29:31:188:199"]},"author_link":["15605","15597","15612","15593","15592","15601","15604","15613","15602","15594","15591","15599","15607","15611","15598","15614","15610","15603","15609","15595","15596","15606","15608","15600"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Treatment strategies and outcomes in heterotopic pregnancy:A report of two cases"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"コトナル チリョウ デ シキュウナイ タイジ オンゾン オ ココロミタ セイショ イショ ドウジ ニンシン ノ ニショウレイ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2021-08-20","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"129","bibliographicPageStart":"123","bibliographicVolumeNumber":"39","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal ","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"正所異所同時妊娠に対し、異なる治療を選択した２例を報告する。症例１は35歳、３妊０産、クエン酸クロミフェンを併用した人工授精を行っていた。人工授精で右卵管妊娠となり腹腔鏡下右卵管切除術を行った既往がある。治療再開後、人工授精で４週２日に妊娠反応陽性となった。７週６日に下腹部痛を訴え受診した。経腟超音波では子宮内と左卵管にそれぞれ胎嚢を認め、ダグラス窩にエコーフリースペースを認めた。血清HCG値は159,788 mIU/mlだった。正所異所同時妊娠の診断で、緊急腹腔鏡下手術の方針とした。左卵管が破裂し、胎嚢様の腫瘤が露出していた。左卵管を摘出し手術終了とした。術直後に経腟超音波で子宮内の胎児心拍を確認した。術後４日目（８ 週３日）で血清HCG値は114,286 mIU/mlに上昇し、経腟超音波で胎児心拍と発育を認め退院となった。しかし、９週２日の外来診察時に稽留流産の診断となった。症例２は35歳、１妊０産、右卵巣チョコレート嚢胞に対して腹腔鏡下右付属器切除を行った既往がある。不妊症に対して体外受精を行っていた。新鮮胚移植で２胚移植し、４週０日に血清HCG値は468.5 mIU/mlと上昇した。８週０日の経腟超音波で子宮内と右卵管切除断端部にそれぞれ胎嚢を確認し、正所異所同時妊娠の診断となった。手術リスクが高く、塩化カリウム局注の方針となった。静脈麻酔下に経腟的に施行し、胎児心拍の消失を確認した。穿刺後14日目に子宮内胎嚢の胎児心拍を確認した上で退院となった。その後子宮内の胎児は順調に発育し、37週２日に自然分娩となった。正所異所同時妊娠は稀な疾患ではあるが、近年の不妊治療の普及に伴い、経験する機会が増える可能性がある。妊娠初期は、正所異所同時妊娠を考慮し慎重に診療にあたる必要がある。正所妊娠児の生存が優先される場合では一般的には手術療法が選択されるが、症例によっては待機療法を選択する必要もあり、それぞれのリスクを十分に考慮することが重要である。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"15599","nameIdentifierScheme":"WEKO"}],"names":[{"name":"サカイ, カズヨシ"}]},{"nameIdentifiers":[{"nameIdentifier":"15600","nameIdentifierScheme":"WEKO"}],"names":[{"name":"マツカワ, ジュン"}]},{"nameIdentifiers":[{"nameIdentifier":"15601","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ナカムラ, フミヒロ"}]},{"nameIdentifiers":[{"nameIdentifier":"15602","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ナカイ, ナナコ"}]},{"nameIdentifiers":[{"nameIdentifier":"15603","nameIdentifierScheme":"WEKO"}],"names":[{"name":"タカハシ, 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pregnancy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"ectopic pregnancy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"infertilityl","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"aparoscopic surgery","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"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 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