大腸癌手術後輸尿管及對側輸尿管吻合術及輸尿管膀胱重建- 病例報告

任駿逸、劉惠瑛

高雄長庚紀念醫院 泌尿科

Reconstruction of complex bladder and bilateral ureteral defect after debulking surgery of colon adenocarcinoma- Case report

Chun-Yi Jen, Hui-Ying Liu

Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract:

A 45-year-old woman with chronic hepatitis B, and sigmoid colon cancer post laparoscopic anterior resection and adjuvant concurrent chemoradiotherapy has been followed for colon cancer at outpatient department of proctology in our hospital. There was no specific discomfort, but recent positron emission tomography-computed tomography scan (PET-CT) demonstrate focal areas of increased uptake in the presacral and left pelvic regions. She underwent laparotomy surgery of excision of pelvic metastatic lesions. Urologist was consulted as direct invasion of bladder and bilateral distal ureter by the colon tumor was noticed during the operation. The defect of bilateral ureter were 5 centimeters on the right side, and 20 centimeters on the left side. Most of the bladder were resected with nearly trigone remained. The cystorrhaphy and right ureteroneocystostomy (UNC) were performed. Left side ureteroneocystostomy couldn’t be performed due to long segment of ureter was resected and small capacity of bladder remained. The use of ileum as ureteral replacement is not suitable for this patient due to history of radiotherapy. Therefore transureteroureterostomy (TUU) with end-to-side anastomosis was performed to re-establish ureteral continuity. Bilateral double-J ureteral stents were inserted. The traditional reconstruction method may give a solution to this patient.