薄筋筋皮弁充塡術後の再発直腸膀胱瘻に対する経肛門的内視鏡下マイクロサージェリー（TEM）による修復術

Transanal endoscopic microsurgery for recurrent rectovesical fistula after gracilis muscle interposition following radical prostatectomy

◆要旨：患者は62歳，男性．2015年に前医で前立腺癌に対しロボット支援腹腔鏡下根治的前立腺摘除術が施行された．術後1か月で直腸膀胱瘻を指摘された．保存療法で改善せず，術後11か月目に薄筋筋皮弁充塡による瘻孔閉鎖術が施行された．術後1か月で再発し，当院に紹介となった．術後7か月後にTEMおよび人工肛門造設術を施行した．瘻孔部の切除を行い，直腸筋層重層縫合で閉鎖した．術後2か月目に完全閉鎖を確認し，人工肛門を閉鎖した．6か月後の現在，瘻孔の再発はない．前立腺癌手術後の難治性直腸膀胱瘻の薄筋筋皮弁充塡術後再発に対し，TEMによる修復術を行い良好な経過を得た症例を経験したので報告する．

Rectovesical fistula is a rare complication following prostatectomy. This case report describes a 62-year-old male patient, who presented with recurrent rectovesical fistula after gracilis muscle interposition following radical prostatectomy. In 2015, he underwent a robotic assisted laparoscopic prostatectomy for prostate cancer. One month after surgery, the patient became aware of pneumaturia, and rectovesical fistula was diagnosed. Repair of rectovesical fistula was attempted by gracilis muscle interposition 11 months after prostatectomy. However, the fistula recurred 1 month later. He was referred to our hospital and we tried to repair the fistula by transanal endoscopic microsurgery （TEM） and ileostomy was constructed. Complete cure and closure of the fistula was confirmed 2 months after TEM, and then the ileostomy was revised. There has been no sign of recurrence six months after surgery. Even after the failure of gracilis muscle interposition following radical prostatectomy, TEM was successfully performed for the repair of recurrent rectovesical fistula.