摘要
目的报告1例髂外动脉-回肠输出道瘘病例,探讨髂外动脉-回肠输出道瘘的发病机制及诊治方法。方法患者女性,67岁,诊断为膀胱浸润性尿路上皮癌,临床分期T2N0M0。行机器人辅助腹腔镜下根治性膀胱切除+扩大淋巴结清扫+Bricker回肠膀胱术。术中出现右侧髂外动脉起始部损伤,即刻行右髂外动脉原位修补术。术后恢复顺利,痊愈出院。术后1个月余突然出现回肠输出道大量肉眼血尿。数字减影血管造影(DSA)示:右侧髂外动脉起始部假性动脉瘤形成,瘤体与回肠输出道相通,确诊为右髂外动脉-回肠输出道瘘。局部麻醉下行右髂内动脉栓塞和覆膜支架管右髂外动脉瘤腔内隔绝术。结果本例手术顺利,术中腔内治疗完毕后DSA示:右髂外动脉假性动脉瘤消失,无造影剂外溢。术后血尿消失,无发热、下肢发凉、疼痛等症状。随访3个月未见血尿复发,彩超检查:右下肢动脉、静脉未见明显异常。结论髂外动脉-回肠输出道瘘临床罕见,以大量肉眼血尿、低血压、失血性休克为特点,DSA是重要的诊断方法,血管内覆膜支架管植入术是治疗髂外动脉-回肠输出道瘘安全、有效的方法。
Objective To report a case of external iliac artery-ileum conduit fistula,and to investigate the pathogenesis,diagnosis and treatment.Methods A 67-year-old female patient was diagnosed as invasive urothelial carcinoma of bladder(T2N0M0),and underwent robotic assisted laparoscopic radical cystectomy+enlarged lymph node dissection+Bricker ileocystectomy.Injury of the initial part of the right external iliac artery was observed during the operation and in situ vascular suture repair was immediately performed.The patient recovered smoothly and was discharged.However,about 1 month after the operation,a large amount of gross hematuria suddenly appeared in the ileal conduit.Digital subtraction angiography(DSA)showed that a pseudoaneurysm was formed at the beginning of the right external iliac artery,and the pseudoaneurysm was connected to the ileal conduit.The diagnosis was a right external iliac artery-ileal conduit fistula.Right internal iliac artery embolization under local anesthesia and endovascular exclusion of right external iliac aneurysm with stent grafting were performed.Results After intraoperative endovascular treatment,DSA showed that the pseudoaneurysm of the right external iliac artery disappeared and there was no spillage of contrast agent.Hematuria disappeared,and there was no fever,cold lower limbs,pain or other complications.There was no recurrence of hematuria during the follow-up of 3 months.Color Doppler ultrasound examination showed no obvious abnormalities in the arteries and veins of the right lower limb.Conclusion External iliac artery-ileum conduit fistula is rare in clinic,which is characterized by massive gross hematuria,hypotension and hemorrhagic shock.DSA is an important diagnostic method.Endovascular stent grafting is a safe and effective treatment.
作者
夏维
刘佛林
邹晓峰
伍耿青
袁源湖
廖云峰
吴玉婷
何志华
钟子芳
徐江广
赖世昌
XIA Wei;LIU Folin;ZOU Xiaofeng;WU Gengqing;YUAN Yuanhu;LIAO Yunfeng;WU Yuting;HE Zhihua;ZHONG Zifang;XU Jiangguang;LAI Shichang(Department of Urology,First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China)
出处
《现代泌尿外科杂志》
CAS
2021年第11期962-965,共4页
Journal of Modern Urology
关键词
髂动脉
回肠输出道瘘
血尿
覆膜支架
iliac artery
ileal conduit fistula
hematuria
stent grafting
