後腹膜鏡下腎尿管摘除術を施行した回腸導管造設後の右腎盂腫瘍

Retroperitoneoscopic nephroureterectomy for recurrence of the right renal pelvic tumor after radical cystectomy with ileal conduit formation

　症例は74歳，男性。72歳時に膀胱全摘除術，回腸導管造設術が施行された。術後2年目に右腎盂腫瘍を認め，後腹膜鏡下用手補助併用腎尿管摘除術を施行した。後腹膜鏡下に，右尿管の走行および回腸導管吻合部を観察できた。腎茎部の動静脈を結紮・切断後，用手補助下に腎周囲を剝離し，さらに直視下に導管尿管吻合部の切除および縫合閉鎖とともに腎尿管を摘出した。後腹膜鏡下手術は，回腸導管造設後の再発性上部尿路腫瘍に対しても有用な手術であると考えられる。

A 74-year-old man underwent radical cystectomy with ileal conduit formation for invasive bladder cancer two years ago. Because recurrence of the right renal pelvic tumor was recognized we underwent retroperitoneoscopic nephroureterectomy with hand-assist method.

We could identity right ureter and uretero-ileal anastomosis region by retroperitoneoscope. Resection of ureter at uretero-ileal anastomosis region was performed by direct vision through incised round. We believe retroperitoneoscopic nephroureterectomy is useful treatment for upper urinary tract tumor even in patient with radical cystectomy and ileal conduit formation.