S状結腸膀胱瘻に対する腹腔鏡下手術における吸収性ステイプルの使用経験

Sigmoid colovesical fistula laparoscopically divided by absorbable suture

◆要旨：患者は43歳，男性．主訴は発熱，排尿時痛，血尿．膀胱造影，注腸検査でS状結腸膀胱瘻を確認した．保存的に炎症を沈静化し，腹腔鏡下S状結腸切除，瘻孔切除を施行した．瘻孔の膀胱側は術後膀胱結石を懸念して吸収性ステイプルで閉鎖し，結腸側は超音波切開凝固装置で切離した．インジコカルミンを静注したが瘻孔切離後に青色尿の腹腔内への漏出はなかった．結腸吻合は直視下でdouble stapling法とした．術後14日目の膀胱造影で漏出のないことを再確認した．吸収性ステイプルは異物が残らず術後の膀胱結石を予防し，結腸膀胱瘻の切離に有用であった．瘻孔を伴う結腸憩室炎に対しても感染を制御することで低侵襲な腹腔鏡下手術が可能と考えられた．

　A 43-year-old man was admitted to our hospital for fever, uriction pain and hematuria. Cystography and gastrographin enema showed a colovesical fistula caused by sigmoid-colon diverticulitis. After an improvement of diverticulitis by conservative therapy, resection of the fistula and sigmoid colon was performed electively. The fistula was closed by absorbable suture to prevent cysotlithiasis and resected by laparoscopic coagulating shears. No leakage of the urine was found by a test using indigo carmine dye. A colonic anastomosis was performed by double stapling technique. Cystography on 14 th postoperative day confirmed a complete closure of the fistula. Because the absorbable suture does not leave any foreign body, it is an useful device to prevent the formation of cystolithiasis after the resection of colovesical fistula. The present case showed the feasibility of a conservative chemotherapy for diverticulitis followed by a laparoscopic surgery as minimal invasive treatment of colovesical fistula due to colonic diverticulitis.