後腹腔鏡腎臟輸尿管切除術所引發之腸道併發症

盧則宏、歐建慧

國立成功大學醫學院附設醫院 泌尿部

Bowel complication in retroperioneoscopic Nephroureterctomy

Lu ZH , Ou CH

Department of Urology, National Cheng Kung University Hospital, College of Medicine,

National Cheng Kung University, Tainan, Taiwan

Purpose:  

Bowel complication in retroperitoneoscopic nephroureterectomy is relatively rare condition. We reviewed the incidence and possible mechanisms of bowel complication in single medical center. Material and methods: During 2006-2015 October, we performed 550 retroperitoneoscopic nephroureterectomy in NCKU hospital. We reviewed all cases including chart record, operation note, assessed the incidence of bowel complication and analyzed etiology, management and outcomes. 

Results: 3 cases(0.55%) had bowel complication,including 2 bowel perforation and 1 small bowel obstruction. No intraoperatively bowel injury was identified.  Two patients with bowel perfoation were detected by massive drainage amount, and abnormal drainage color on postoperative 4th and 7th day. One patient developed small bowel obstruction 3 weeks after surgery. All 3 cases underwent exploratory laparotomy. In 2 cases of bowel perforation, no evidence of needle, cutting , or suture injury or thermal injury was noted around injury site. Possible mechanism of injury may related to previous abdominal operation history, which resulted in adhesion over intestine and peritoneum, and micro-injury may happenwhen we dissected retroperitoneal space. In the case of small bowel obstruction, the cause of small bowel obstruction was internal herniation due to peritoneal defect.

Conclusion:

Previous abdominal operation history and locally advanced cancer may connected to higher bowel injury rate during retroperitoneoscopic nephroureterectomy. Careful retroperitoneal dissection, inspection of surgical field again after the surgery, and repair of peritoneal defect are  needed in these cases. Monitoring surgical drainage can detect bowel injury earlier, and early intervention may lower morbidity and mortality.