Kamada Teppei, Nakaseko Yuichi, Yoshida Masashi, Kai Wataru, Takahashi Junji, Nakashima Keigo, Suzuki Norihiko, Ohdaira Hironori, Yamanouchi Eigoro, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan.
Department of Radiology, International University of Health and Welfare Hospital, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Surg Case Rep. 2021 Mar 12;7(1):67. doi: 10.1186/s40792-021-01153-3.
Iatrogenic ureteral injury (UI) is a potentially serious complication of colorectal cancer surgery. Performing perioperative placement of ureteral stents or intraoperative fluorescence navigation surgery for the ureter using indocyanine green (ICG) has been employed as a method of preventing UI. However, transileal conduit stent placement has been considered challenging because it is difficult to identify the ureteral orifice due to the anatomical changes caused by a previous surgery. We report a case in which laparoscopic colectomy was safely performed using a combination of prophylactic transileal conduit ureteral catheter placement and intraoperative ICG fluorescence navigation surgery.
A 75-year-old man presented to our hospital complaining of vomiting and abdominal distension. He had a history of open total cystectomy and ileal conduit urinary diversion 11 years prior to admission. Computed tomography confirmed colon dilation with fecal impaction from the ascending colon to the sigmoid colon and wall thickening in the sigmoid colon. Colonoscopy during the transanal ileus tube insertion revealed a Borrmann type II tumor with circumferential stenosis 10 cm distal to the junction between the descending colon and the sigmoid colon. The patient was diagnosed with colorectal ileus due to obstructive sigmoid colon cancer and underwent transanal ileus tube insertion. Severe intra-abdominal adhesions were expected due to the previous total cystectomy, and the left ureter was near the sigmoid colon tumor; therefore, prophylactic retrograde transileal conduit ureteral catheter placement was performed one day before the elective surgery. During the operation, 20 ml (5.0 × 10 mg/ml) ICG was administered from the transileal conduit ureteral catheter, and ICG fluorescence of the ureter was observed in the retroperitoneum. Laparoscopic Hartmann's operation was successfully performed, confirming ureter fluorescence. The operation time was 231 min, with 5 mL of intraoperative bleeding. The ureteral catheter was removed 3 days after the operation. The patient's postoperative course was good with no complications, and he was discharged on postoperative day 7.
Prophylactic transileal conduit ureteral catheter placement and ICG fluorescence navigation surgery were effective in performing laparoscopic colorectal surgery with severe adhesions after urinary diversion.
医源性输尿管损伤（UI）是结直肠癌手术中一种潜在的严重并发症。在围手术期放置输尿管支架或术中使用吲哚菁绿（ICG）进行输尿管荧光导航手术已被用作预防UI的方法。然而，经回肠通道放置支架被认为具有挑战性，因为既往手术引起的解剖结构改变使得输尿管口难以识别。我们报告了一例通过预防性经回肠通道输尿管导管置入联合术中ICG荧光导航手术成功实施腹腔镜结肠切除术的病例。
一名75岁男性因呕吐和腹胀入住我院。他在入院前11年有开放性全膀胱切除术及回肠通道尿流改道术史。计算机断层扫描证实结肠扩张，从升结肠至乙状结肠存在粪便嵌塞，乙状结肠壁增厚。经肛门插入肠梗阻导管期间的结肠镜检查显示，在降结肠与乙状结肠交界处远端10 cm处有一个Borrmann II型肿瘤，伴有环形狭窄。该患者因乙状结肠癌梗阻被诊断为结直肠肠梗阻，并接受了经肛门肠梗阻导管插入术。由于既往全膀胱切除术，预计会有严重的腹腔内粘连，且左输尿管靠近乙状结肠肿瘤；因此，在择期手术前一天进行了预防性逆行经回肠通道输尿管导管置入。手术过程中，通过经回肠通道输尿管导管注入20 ml（5.0×10 mg/ml）ICG，在腹膜后观察到输尿管的ICG荧光。成功实施了腹腔镜Hartmann手术，确认输尿管荧光。手术时间为231分钟，术中出血5 ml。术后3天拔除输尿管导管。患者术后恢复良好，无并发症，术后第7天出院。
预防性经回肠通道输尿管导管置入和ICG荧光导航手术对于在尿流改道后有严重粘连的情况下进行腹腔镜结直肠手术是有效的。
