右腎結石合併下大静脈後尿管に対して尿管切断・内視鏡下結石摘出・尿管尿管吻合を後腹膜鏡下に施行した1例

Retroperitoneoscopic reconstruction of retrocaval ureter, and simultaneous ureteroscopic removal of a renal stone via a trocar port : a case report

◆要旨：患者は32歳，男性．右側腹部痛を主訴に近医を受診し，腎結石と下大静脈後尿管と診断され加療目的に当科に紹介された．手術はまず後腹膜腔鏡下に下大静脈から尿管を剝離し，切断した．次いでトロッカーポートから軟性尿管鏡を腎盂内に挿入し，腎結石を摘出した後に尿管吻合を施行した．これまで下大静脈後尿管の結石合併例にこのような術式で一期的手術を行った例はなく，おそらく本例が最初の報告であると思われる．

　A 32-year-old male was referred to our institution for the management of reterocaval ureter and a renal stone. Placing of a single-J ureteral catheter in advance, retroperitoneoscopic dissection and transection of the ureter was performed with 4 trocars. Then, 6.9 Fr flexible ureteroscope was inserted into the stump of the ureter via a trocar port in order to retrieve the renal stone using basket ureteral catheter. After removal of the stone, end-to-end anastomosis of the ureter was created with 4-0 Polygractin sutures endoscopically over a double J stent. The operative time for this procedure was 288 minutes with an estimated blood loss of 20 ml. The patient was discharged without operative complications. The ureteral stent was removed 4 weeks post-operatively. This is the first report of retroperitoneoscopic treatment for retrocaval ureter with a renal stone using the flexible ureteroscope. Our experience shows that this method is technically feasible and minimally invasive.