經陰道置入尿管引流骨盆底腫瘤積液以緩解急性尿液滯留之案例報告

Trans-vaginal foley insertion in patient with recurrent pelvic ascities for relief of acute urinary retention : a case report

慢性腹水生成為後期卵巢癌常見之徵狀，一旦累積到一定程度，時常導致腹脹、食慾不振、腹腔內感染或是腹壓上升造成呼吸困難。也因為卵巢癌之高復發率，這些症狀也時常造成病人長久的不適。本案例介紹一57 歲女性患有第三期卵巢癌，經過減積手術和六次化學治療後復發，並且因大量快速的腹水生成，累積在骨盆底壓迫泌尿系統，導致阻塞性尿路疾病。病人接受多次的經陰道超音波導引細針抽吸骨盆腔積液，仍反覆復發急性尿液滯留，最後接受經陰道尿管置入持續引流膀胱直腸凹窩之積液後，沒有再復發之情形。使用大尺寸尿管進行經陰道骨盆腔積液引流可以達到良好的持續引流效果，並大幅減少引流管阻塞之情形，不須做縫合的步驟，尿管水球就有良好的引流管固定效果；此外，尿管置入前的陰道切開術 (colpotomy)，所需用的器械簡便，可在具有簡單配備的手術室中快速完成。

Chronic ascites is a common presentation of advanced ovarian cancer. It often leads to abdominal distension, poor appetite, intra-abdominal infection, or dyspnea due to increased abdominal pressure. These symptoms often induce long-term discomfort because of the high recurrent rate of ovarian cancer. We present this 57-year-old woman with stage III ovarian cancer with recurrence after debulking surgery and six cycles of chemotherapy. Due to the rapid generation of a large amount of ascites, it accumulated in the pelvis and compressed the urinary system, resulting in obstructive urinary tract disease. The patient underwent multiple transvaginal ultrasound-guided fine-needle aspirations of pelvic ascites, but acute urinary retention still recurred. Finally, the patient underwent trans-vaginal foley insertion to continuously drain the ascites in the cul-de-sac and utero-vesical pouch without recurrent ascites. Using a large-sized foley for trans-vaginal ascites drainage can achieve a con- tinuous drainage effect and significantly reduce the obstruction of the drainage tube. There is no need for a suture due to the fixation effect of the urinary catheter water polo. In addition, colpotomy before foley insertion just requires simple instruments and can be quickly completed in the operative room.