Yamasaki Toshinari, Yagihashi Yuusuke, Shirahase Toshiaki, Hashimura Takayuki, Okuno Teruaki, Kudou Takehumi, Maruta Tsutomu
Department of Urology, Himeji Medical Center.
Hinyokika Kiyo. 2004 Sep;50(9):641-4.
We report a case of ureteral-iliac artery fistula and its minimally invasive management with endovascular stent grafting. A 76-year-old male was admitted with massive gross hematuria from an ilial conduit. He underwent a radical cystectomy with ileal loop urinary diversion for bladder cancer 7 months ago and had undergone placement of a 7 Fr single-J ureteral catheter for repair of a partial disruption of the left ureteroileal anastomosis. Although the fistula was not confirmed radiographically, a left ureteral-common iliac artery fistula was highly suspected. The patient was treated by percutaneous placement of an autoexpandable covered stent graft across the left common iliac and left external iliac artery. After successful endovascular management of the ureteroarterial fistula, the patient's hematuria resolved and he recovered fully. During 10 months of follow up, he has been free of hemorrhagic episodes. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide a safety treatment alternative.
我们报告一例输尿管-髂动脉瘘及其采用血管内支架植入术的微创治疗。一名76岁男性因回肠代膀胱出现大量肉眼血尿入院。他7个月前因膀胱癌接受了根治性膀胱切除术及回肠袢尿流改道术,并曾置入一根7F单J型输尿管导管以修复左输尿管-回肠吻合口部分破裂。尽管瘘口在影像学上未得到证实,但高度怀疑存在左输尿管-髂总动脉瘘。该患者接受了经皮在左髂总动脉和左髂外动脉置入自膨式覆膜支架。成功进行输尿管动脉瘘的血管内治疗后,患者血尿消失并完全康复。在10个月的随访期间,他未再出现出血情况。由于开放手术修复可能困难且伴有显著的并发症风险,血管内介入治疗可能提供一种安全的治疗选择。