Title

Laparoscopy-Assisted Ileal Conduit Diversion for Intractable Hematuria from Radiation Cystitis

Translated Titles

腹腔鏡協助下迴腸尿路引流用以治療放射線性膀胱炎導致之嚴重血尿

DOI

10.6200/TCMJ.2005.2.12.08

Authors

陳翹業(James K. Tan);廖建華(Alex C. Liao);黃冠華(Steven K. Huan);薛又仁(Thomas Y. Hsueh);邱文祥(Allen W. Chiu)

Key Words

腹腔鏡 ; 血尿 ; 放射線性膀胱炎 ; Laparoscopy ; hematuria ; radiation cystitis

PublicationName

北市醫學雜誌

Volume or Term/Year and Month of Publication

2卷12期(2005 / 12 / 01)

Page #

1146 - 1150

Content Language

英文

Chinese Abstract

目的:放射線性出血性膀胱炎所造成之持續出血在臨床上是-困難處理的問題。無論是用膀胱內電燒、膀胱沖洗、多次輸血或是高壓氧治療,最後都可能要用迴腸尿路引流來解決此可能危及生命之問題。為了減少手術之合併症,可利用低侵襲性之腹腔鏡技術游離雙側輸尿管來引流尿液。我們利用此方法成功治療二位罹患放射線性膀胱炎合併嚴重出血之病患。案例報告:二位76及78歲之病患因侷限性攝護腺癌接受放射線治療後發生膀胱炎,接受腹腔鏡迴腸尿路引流手術後成功治療嚴重血尿。在接近內外骼血管分支處發現輸尿管之後,將輸尿管加以游離並在接近輸尿管膀胱交界處切斷;再將左側輸尿管自乙狀結腸之腸系膜中穿出至右下腹部。之後利用腹腔鏡手術時位於右側之5毫米及10毫米之手術套管間建立一約6公分的傷口,並將雙側輸尿管及一部份之迴腸經由此傷口移至體外。迴腸尿液引流(包括迴腸接合及雙側輸尿管迴腸吻合術)則利用此一傷口於體外完成。手術時問分別為3.5及5.5小時。在手術後6個月的追蹤期,此二位病患均未有血尿或尿路感染復發的現象。結論:腹腔鏡協助進行迴腸尿路引流的初步經驗顯示,其具有可接受之手術時間及術後併發症較少之優點。與傳統之開腹進行迴腸尿路引流手術相比,其可視為一合理且可替代之方式。

English Abstract

Background and Purpose: Intractable hematuria from radiation-induced hemorrhagic cystitis is a difficult clinical problem to manage. Despite treatment with cystodiathermy, bladder washout, multiple transfusions and even hyperbaric oxygen therapy, urinary diversion with ileal conduit formation may be a last resort life saving measure. To decrease the morbidity of this procedure, minimally invasive laparoscopic techniques can be employed to mobilize and prepare both ureters. We present two cases of laparoscopy-assisted ileal conduit urinary diversion which were performed for intractable hematuria secondary to radiation cystitis. Case Reports: Two elderly males aged 76 and 78, developed intractable hematuria after having had radical radiation therapy previously for localized prostate cancer. Laparoscopy-assisted ileal conduit formation was done. The ureters were located at the bifurcation of the iliac vessels, mobilized and divided near the uretero-vesical junction. The left ureter was tunneled under the sigmoid mesocolon towards the right lower abdomen. By making a 6cm muscle splitting abdominal incision joining the right 5 and 10mm ports, the ureters and a segment of the ileum were externalized. The ileal conduit including the enteroenterostomy and the bilateral ureteroenterostomy was done extra-corporally. The operating time was 3.5 and 5.5 hours for the first and second case respectively. At 6 months post-operatively, both patients were well with no recurrence of hematuria or urosepsis. Conclusion: Laparoscopy-assisted ileal conduit diversion in this initial experience was associated with acceptable operative time and minimal post-operative morbidity. It may serve as a reasonable minimally invasive alternative to conventional open ileal conduit diversion.

Topic Category 醫藥衛生 > 醫藥衛生綜合