Hori Naoto, Matsumoto Makoto, Miyamoto Kokichi, Mizuno Kenji, Kodera Masahito, Oishi Masahiro
Department of Surgery, Tottori City Hospital, Tottori, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70108. doi: 10.1111/ases.70108.
A 72-year-old man who underwent laparoscopic radical cystectomy and ileal conduit construction for bladder cancer exhibited sigmoid colonic wall thickening and metastatic liver and lung lesions on surveillance CT. Colonoscopy revealed semicircular type 2 advanced sigmoid colon carcinoma. The primary tumor and metastases were resectable. However, preoperative weight reduction was prioritized owing to the patient's BMI of 35.5. Chemotherapy was administered during their weight loss. After 2 months, the patient's BMI decreased to 32.2, and elective surgery was performed. Anatomical alterations rendered preoperative placement of fluorescent ureteral stent unfeasible. Three-dimensional CT reconstruction was used for preoperative planning. Intraoperatively, careful dissection of adhesions between the left iliac vessels and the sigmoid colon helped identify the left ureter near the sacral promontory, ensuring safe resection. Patient recovery was uneventful. Patients undergoing ileal conduit owing to bladder cancer require prior surgical records, preoperative imaging, and precise intraoperative techniques for surgical planning and urinary tract preservation.
一名72岁男性因膀胱癌接受了腹腔镜根治性膀胱切除术和回肠膀胱术,在监测CT上显示乙状结肠壁增厚以及肝脏和肺部转移病变。结肠镜检查发现半圆形2型进展期乙状结肠癌。原发肿瘤和转移灶均可切除。然而,由于患者的BMI为35.5,术前减重被列为优先事项。在减重期间进行了化疗。2个月后,患者的BMI降至32.2,随后进行了择期手术。解剖结构的改变使得术前放置荧光输尿管支架不可行。术前规划采用了三维CT重建。术中,仔细分离左髂血管和乙状结肠之间的粘连有助于在骶岬附近识别左输尿管,确保安全切除。患者恢复顺利。因膀胱癌接受回肠膀胱术的患者需要既往手术记录、术前影像学检查以及精确的术中技术来进行手术规划和保留尿路。