Indocyanine green fluorescence-guided laparoscopic colorectal cancer surgery with prophylactic retrograde transileal conduit ureteral catheter placement after previous total cystectomy: a case report.
Indocyanine green fluorescence-guided laparoscopic colorectal cancer surgery with prophylactic retrograde transileal conduit ureteral catheter placement after previous total cystectomy: a case report.
复制标题
吲哚青绿荧光引导的腹腔镜结直肠癌手术预防性逆行输尿管导管置入术：病例报道。
DOI：
10.1186/s40792-021-01153-3
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发表时间：
2021-03-12
影响因子：
0.8
通讯作者：
Suzuki Y
中科院分区：
文献类型：
--
作者：
Kamada T;Nakaseko Y;Yoshida M;Kai W;Takahashi J;Nakashima K;Suzuki N;Ohdaira H;Yamanouchi E;Suzuki Y
医源性输尿管损伤（UI）是结直肠癌手术的潜在严重并发症。使用吲哚菁绿色（ICG）进行输尿管支架的围手术期放置或输尿管的术中荧光导航手术已被用作预防UI的方法。然而，由于先前手术引起的解剖结构变化，难以识别输尿管口，因此经叶管道支架置入一直被认为具有挑战性。我们报告了一个病例，其中腹腔镜结肠切除术安全地进行了预防性经皮管道输尿管导管放置和术中ICG荧光导航手术的组合。一位75岁的男性到我院就诊，主诉呕吐和腹胀。他在入院前11年有开放性全膀胱切除术和回肠导管尿流改道的病史。计算机断层扫描证实结肠扩张，粪便从升结肠嵌塞到乙状结肠，乙状结肠壁增厚。在经肛门肠梗阻管插入过程中的结肠镜检查显示Borrmann II型肿瘤，在降结肠和乙状结肠交界处远端10 cm处有环形狭窄。患者被诊断为梗阻性乙状结肠癌导致的结直肠肠梗阻，并接受了经肛门肠梗阻管插入术。由于之前的全膀胱切除术，预计会发生严重的腹腔内粘连，并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皮管道输尿管导管放置。术中经输尿管导管注入ICG 20 ml（5.0 × 10-2 mg/ml），在腹膜后观察输尿管的ICG荧光。成功进行腹腔镜Hartmann手术，证实输尿管荧光。手术时间231 min，术中出血5 mL。术后3天拔除输尿管导管。患者术后病程良好，无并发症，术后第7天出院。预防性经皮导管输尿管导管放置和ICG荧光导航手术在尿流改道后严重粘连的腹腔镜结直肠手术中有效。
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 × 10–2 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.