Su Yi-Wei, Chang Li-Wen, Li Jian-Ri, Chiu Kun-Yuan, Hung Sheng-Chun
Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
J Endourol Case Rep. 2020 Dec 29;6(4):343-347. doi: 10.1089/cren.2020.0121. eCollection 2020.
Drainage tubes are almost always routinely used after a laparoscopic or robot-assisted radical prostatectomy and pelvic lymphadenectomy to prevent urinoma formation and lymphoceles. They are seldom of any consequence. We present our unique experience of bowel obstruction resulting from the use of pelvic drains. We are reporting on two prostate cancer cases with rare postoperative complications. Each of them received robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection and subsequently developed ileus and bowel obstruction. Series follow-up images suggested the bowel obstruction was related to their drainage tube. No evidence of urine leakage or intestine perforation was found based on drainage fluid analysis. We performed exploratory laparotomy in the first patient and found drainage tube kinking with the terminal ileum and adhesion band. The drainage tube was removed and patient recovery occurred over the following days. In the second case, the patient experienced bowel obstruction for 4 days after surgery. Based on our experience in the first case, and a drainage fluid survey showing no evidence of urine leakage, we removed the drainage tube on the morning of the 4th day, giving the patient a dramatic recovery with flatus and stool passage occurring in the afternoon. Both of the patients recovered well in hospital and during regular follow-up. To best of our knowledge, despite there being certain case reports regarding drainage tube ileus in colorectal and bowel surgery, we have reported here on the first two cases of small bowel obstruction as a complication arising from the abdominal drainage tube used in robot-assisted urology surgery.
在腹腔镜或机器人辅助根治性前列腺切除术及盆腔淋巴结清扫术后，几乎总是常规使用引流管以预防尿瘤形成和淋巴囊肿。它们很少会造成任何后果。我们介绍了因使用盆腔引流管导致肠梗阻的独特经验。我们报告了两例前列腺癌患者出现罕见术后并发症的情况。他们每人都接受了机器人辅助腹腔镜根治性前列腺切除术和双侧盆腔淋巴结清扫术，随后出现了肠梗阻。系列随访影像显示肠梗阻与他们的引流管有关。根据引流液分析，未发现尿液渗漏或肠穿孔的证据。我们对第一例患者进行了剖腹探查，发现引流管与回肠末端扭结并有粘连带。引流管被移除，患者在接下来的几天里康复。在第二例中，患者术后4天出现肠梗阻。基于我们在第一例中的经验，以及引流液检查未发现尿液渗漏的证据，我们在第4天上午移除了引流管，患者在下午出现排气和排便，病情显著恢复。两名患者在住院期间及定期随访中均恢复良好。据我们所知，尽管在结直肠和肠道手术中有关于引流管性肠梗阻的某些病例报告，但我们在此报告了首例因机器人辅助泌尿外科手术中使用的腹部引流管引起的小肠梗阻并发症的两例病例。
