外傷を契機に発症した腎盂尿管移行部狭窄症に対し腹腔鏡下腎盂形成術を施行した1例

Abstract

25歳男.左側腹部痛を主訴とした.単車走行中に転倒, 左腰部を打撲し, 近医で左腎損傷を指摘された.その後, 左腎被膜外血腫を生じ, 保存的治療で軽快した.受傷4年後に左腰背部痛を自覚し, US, CTで左水腎が認められたため, 腎盂尿管移行部狭窄症の診断のもとballoon dilationを2回受けたが改善しなかった.入院時の検査ではCTで水腎を認め, RPでは腎盂尿管移行部に狭窄を認め, レノグラムでは左腎は完全閉塞型であった.腎損傷を契機に発症した腎盂尿管移行部狭窄症と診断し, 腹腔鏡下腎盂形成術を施行した.術後経過は良好で, 術後5日目にドレーン抜去, 9日目に尿道カテーテル抜去, 5週目にD・Jカテーテルを抜去した.術後5ヵ月の現在, IVPにて腎盂尿管移行部の狭窄所見は改善し, 中部及び下部尿管の抽出を認めた.水腎及び腎機能は改善し, 自覚症状は消失した

We report a case of secondary ureteropelvic junction obstruction due to renal trauma treated by laparoscopic pyeloplasty. A 25-year-old man, who had renal trauma due to a traffic accident, complained of left lumbago and was diagnosed with left ureteropelvic junction obstruction. Endoscopic balloon dilation was performed twice, but the hydronephrosis did not change. Subsequently, laparoscopic pyeloplasty was performed with no complications. After operation, lumbago disappeared and hydronephrosis and renal function improved. Secondary ureteropelvic junction obstruction is rare, and this case seems to be the first case managed by laparoscopy in Japan.