Inoue K, Nishimura K, Isogawa Y, Ohmori K
Department of Urology, Osaka Red Cross Hospital.
Hinyokika Kiyo. 1998 Apr;44(4):285-8.
We report two rare cases of delayed ureteral fistulas which occurred one month following rectal amputation. Case 1 was a 52-year-old male who underwent abdominal perineal resection of the rectum. One month after surgery, the patient had a paralytic ileus. Computed tomographic (CT) scan and drip infusion pyelography showed left ureteral fistula and a large pelvic urinoma. Because retrograde placement of a double-J stent was unsuccessful, antegrade placement of the double-J stent was performed. The fistula and urinoma healed soon after the placement of the double J stent. Case 2 was a 43-year-old male who underwent abdominal sacral resection of the rectum. One month after surgery, a large amount of urine began to drain from the perineal wound. CT scan and retrograde pyelography showed a right ureteral fistula and a large pelvic urinoma. There had been temporary improvement in the discharge without the treatment of the ureteral fistula, only for it to return more profusely. Because placement of a double-J stent was unsuccessful, right percutaneous nephrostomy was performed, after which, a right ureterocysto-neostomy (Boari flap method) was performed. We advocate the initial use of the double-J stent or percutaneous nephrostomy in ureteral fistula. This approach is simple and may cure the fistula. If unsuccessful, it will not hinder subsequent open surgery.
我们报告两例罕见的直肠切除术后一个月发生的延迟性输尿管瘘病例。病例1是一名52岁男性，接受了经腹会阴直肠切除术。术后一个月，患者出现麻痹性肠梗阻。计算机断层扫描（CT）和静脉肾盂造影显示左输尿管瘘和巨大盆腔尿瘤。由于逆行置入双J支架失败，遂行顺行置入双J支架。置入双J支架后，瘘口和尿瘤很快愈合。病例2是一名43岁男性，接受了经腹骶骨直肠切除术。术后一个月，大量尿液开始从会阴伤口流出。CT扫描和逆行肾盂造影显示右输尿管瘘和巨大盆腔尿瘤。在未治疗输尿管瘘的情况下，引流曾有短暂改善，但随后又大量复发。由于置入双J支架失败，遂行右经皮肾造瘘术，之后又进行了右输尿管膀胱新造口术（Boari瓣法）。我们主张在输尿管瘘的治疗中首先使用双J支架或经皮肾造瘘术。这种方法简单，可能治愈瘘口。如果不成功，也不会妨碍后续的开放手术。
