回腸導管内視鏡検査における極細上部消化管内視鏡の使用経験

Abstract

症例1:73歳男。6年前に浸潤性膀胱癌で膀胱全摘, 回腸導管造設術を行った。発熱, 左腰痛で受診し, CTで軽度左水腎症, 左尿管拡張を認めたが明らかな閉塞機転はなく, 極細上部消化管内視鏡を行った。内視鏡の生検鉗子を用い腫瘍を2ヶ所生検し, 病巣は移行上皮癌であった。腫瘍再発による左水腎症で追加治療を提案したが強く拒否され外来でフォローした。症例2:70歳男。1年前に浸潤性膀胱癌で膀胱全摘, 回腸導管造設術を行った。術後CTで右水腎症及び骨盤内腫瘤を認め, 逆行性に尿管ステントを留置するため内視鏡検査を行った。尿管ステント留置後, 抗癌剤による治療を開始した。

Using extra slim gastrointestinal endoscopes, we have examined ileal conduits in two patients. This endoscope has almost the same caliber as a flexible cystoscope and has multiple manipulation levers and channels as ordinal gastrointestinal endoscopes. It is often difficult to examine ileal conduits with flexible cystoscopes because ileal conduits lack continent mechanisms and cannot be dilated adequately with water irrigation. With air insufflations, extra slim gastrointestinal endoscopes could adequately distend ileal conduits, and with multiple levers, they provided much more freedom of manipulation than flexible cystoscopes. Visualization of ureterointestinal anastomosis sites and biopsy of tumors could be performed very easily. We strongly recommend the use of extra slim gastrointestinal endoscopes than flexible cystoscopes when retrograde examinations and procedures are necessary in patients with ileal conduits.