後脊椎融合併發完全性輸尿管撕脫造成長段缺損：非機器手臂腹腔鏡治療的一個罕見案例
賴建榮1、張明元2、黃柏堅1、朱元中1
敏盛綜合醫院 外科部 泌尿科1；敏盛綜合醫院 外科部 神經外科2
Complete Ureter Avulsion Causing a Long Defect As a Complication of Posterior Spine Fusion: A Rare Case Treated with Non-robotic Laparoscopic Repair
Chien-Jung Lai1, Ming-Yuan Chang2, Po-Chien Huang1, Yuan-Chung Chu1
Divisions of Urology1, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Neurosurgery2, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
Purpose: Ureter avulsion, a challenging Urologic complication, has been rarely found in lumbar spine surgeries. Once ignored, the leaked urine usually leads to significant morbidity ; further repair also becomes difficult. We present an unusual ureter injury with a long defect which occured in posterior spine fusion ; immediate repair was performed with minimal invasion.
Case presentation: A 61-year-old female was receiving microscopic spine fusion(TLIF) for her L3-5 spondylosis. Ureter avulsion with one 3-centemeter defect occured unexpectedly. We confirmed urine extravasation promptly, and performed end-to-end ureteroureterostomy with laparoscopy. Retrograde double-J stenting was indwelled. Her postoperative condition was uneventful.
Conclusion: This rare case highlights the importance of early diagnosis and immediate repair for complete ureter avulsion. Even with long ureter loss, we prove reanastomosis is feasible with laparoscopy in regional hospitals where robot is not available. To deal with large gap between stumps, adequate kidney mobilization is required before anastomosis.