回腸導管造設術後の直腸癌に対し蛍光尿管カテーテルを用いて腹腔鏡下低位前方切除術を行った1例

A case of laparoscopic low anterior resection using a fluorescent ureteral catheter for rectal cancer after ileal conduit construction

◆要旨：症例は71歳，男性．膀胱癌に対して膀胱全摘除術および回腸導管造設術の既往があった．経過観察のため施行したCT検査で直腸壁の肥厚が指摘され，直腸癌の診断で内視鏡治療が施行されたが追加切除が必要となり当科紹介となった．術中，尿路を確実に温存する必要があり，画像診断により左尿管や回腸導管の走行確認を行い，術前日には経回腸導管的に蛍光尿管カテーテルを留置して腹腔鏡下低位前方切除術を施行した．近赤外光観察により左尿管，回腸導管は容易に同定可能で，安全な剝離層を保ちながら手術を完遂できた．手術時間は340分，出血量は15mL，術後経過は良好で術後12日目に退院した．尿路変向術後の直腸癌手術において，蛍光尿管カテーテルは安全に腹腔鏡下手術を行うために有用であった．

　A 71-year-old man who had a history of total cystectomy with ileal conduit creation for bladder cancer was diagnosed with early rectal cancer by follow up CT scan that showed rectal wall thickness. Although ESD was performed, an additional resection was required from the pathological result, and the patient was referred to the department of surgery. Although the location of the left ureter and ileal conduit could be confirmed by preoperative CT scan, in order to preserve the urinary tract, a fluorescent ureteral catheter was placed via the ileal conduit the day before surgery. Laparoscopic low anterior resection was performed. The left ureter and ileal conduit could be identified easily using near-infrared imaging, and the rectum could be dissected safely without any injury to other organ. The duration of the surgery was 340minutes, and the blood loss was 15mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. In rectal cancer surgery for patients with a history of urinary diversion surgery, the fluorescent ureteral catheter proved to be highly effective.