Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan.
Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Asian J Endosc Surg. 2022 Apr;15(2):397-400. doi: 10.1111/ases.13018. Epub 2021 Dec 7.
A 69-year-old woman underwent abdominoperineal resection for a gastrointestinal stromal tumor (GIST) of the rectum 15 years ago. She received adjuvant chemotherapy for 8 years. Seven years later, abdominal computed tomography revealed a soft-tissue shadow in the left lower abdomen, and fluorodeoxyglucose uptake was observed at the same site on positron emission tomography. The recurrence of GIST was suspected, and laparoscopic resection was performed. Laparoscopy showed that the tumor was located at the retroperitoneum near to the descending colon and invaded the left ovarian vessels. It also made contact with the left ureter; however, lighted ureteral catheters enabled us to identify and preserve the left ureter. An immunohistochemical examination revealed the recurrence of GIST. Recurrence may become apparent 15 years or more after GIST surgery, and, thus, a long-term follow-up is required. Lighted ureteral catheters were useful for identifying the ureter and preventing ureteral injury in a recurrent case suspected of invading the ureter.
一位 69 岁女性 15 年前因直肠胃肠道间质瘤（GIST）接受了腹会阴联合切除术。她接受了 8 年的辅助化疗。7 年后，腹部计算机断层扫描显示左下腹有软组织阴影，正电子发射断层扫描也在同一部位观察到氟脱氧葡萄糖摄取。怀疑 GIST 复发，并进行了腹腔镜切除术。腹腔镜检查显示肿瘤位于降结肠附近的腹膜后，侵犯了左侧卵巢血管。它还与左输尿管接触；但是，有灯光的输尿管导管使我们能够识别并保留左侧输尿管。免疫组织化学检查显示 GIST 复发。GIST 手术后 15 年或更长时间可能会出现复发，因此需要长期随访。在怀疑侵犯输尿管的复发性病例中，有灯光的输尿管导管有助于识别输尿管并防止输尿管损伤。
