PDF(Pubmed)
Abstract：
BACKGROUND: As the world\'s population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery.
METHODS: An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine.
METHODS: Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis.
METHODS: After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal.
RESULTS: Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7.
CONCLUSIONS: The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.
METHODS: An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine.
METHODS: Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis.
METHODS: After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal.
RESULTS: Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7.
CONCLUSIONS: The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.
摘要：
背景：随着世界人口的老龄化，预计继发于结肠憩室炎的结肠膀胱瘘的手术病例数也会增加.对这些瘘管进行腹腔镜手术时的关键问题是避免医源性输尿管损伤。没有近红外射线导管用于憩室炎手术的报道，是输尿管损伤风险最高的疾病之一。我们介绍了一名男性患者，该患者继发于乙状结肠憩室炎，该患者接受了腹腔镜手术，并使用腹腔镜手术中的新手术技术对输尿管进行了可视化。
方法：一名82岁的男子因全身疲劳和尿液中的空气和粪便物质出现在我们的泌尿科。
方法：膀胱造影显示乙状结肠的勾画。腹部计算机断层扫描结果显示多个乙状结肠憩室，壁增厚，大结石和膀胱中少量空气。由于乙状结肠憩室炎，他被诊断为尿路感染并伴有膀胱瘘和膀胱结石。
方法：创建横结肠造口术后，我们安排了腹腔镜前切除术和膀胱结石切除术。
结果：术前乙状结肠周围有严重的炎性粘连和输尿管损伤的高风险。麻醉诱导后,我们插入了一个近红外射线导管,荧光输尿管导管,这使我们能够轻松地实时识别和可视化输尿管。这样可以进行肠解剖，而无需担心输尿管损伤。手术的胃肠道部分的手术时间为150分钟，术后患者一般情况良好，术后第7天出院。
结论：在腹腔镜手术治疗与憩室炎相关的瘘管期间，输尿管导管的绿色荧光可以很容易且快速地识别出输尿管的过程，严重的炎症和致密的纤维化存在。我们的技术是一种简单可行的方法，可在结肠憩室炎继发的膀胱瘘手术过程中提供实时尿道导航。
方法：一名82岁的男子因全身疲劳和尿液中的空气和粪便物质出现在我们的泌尿科。
方法：膀胱造影显示乙状结肠的勾画。腹部计算机断层扫描结果显示多个乙状结肠憩室，壁增厚，大结石和膀胱中少量空气。由于乙状结肠憩室炎，他被诊断为尿路感染并伴有膀胱瘘和膀胱结石。
方法：创建横结肠造口术后，我们安排了腹腔镜前切除术和膀胱结石切除术。
结果：术前乙状结肠周围有严重的炎性粘连和输尿管损伤的高风险。麻醉诱导后,我们插入了一个近红外射线导管,荧光输尿管导管,这使我们能够轻松地实时识别和可视化输尿管。这样可以进行肠解剖，而无需担心输尿管损伤。手术的胃肠道部分的手术时间为150分钟，术后患者一般情况良好，术后第7天出院。
结论：在腹腔镜手术治疗与憩室炎相关的瘘管期间，输尿管导管的绿色荧光可以很容易且快速地识别出输尿管的过程，严重的炎症和致密的纤维化存在。我们的技术是一种简单可行的方法，可在结肠憩室炎继发的膀胱瘘手术过程中提供实时尿道导航。
