Extravesical dismembered antireflux surgeryの経験

Abstract

extravesical antireflux surgeryを施行した小児VUR患者38例61尿管について検討した。1) VUR消失は31例53尿管にみられた。2) 8歳未満の23例36尿管では1例1尿管のみ逆流継続し, 成績良好であった。3)早期合併症の肉眼的血尿, 膀胱刺激症状はintravesical methodに比べ明らかに少なく, 重篤な晩期合併症もなかった。4) extravesical antireflux surgeryは術後合併症がintravesical methodにくらべ明らかに軽度である利点を有する。しかし手術成功率が8歳を境に年齢による差がみられ, 膀胱の大きさに対する粘膜下トンネルの長さの十分不十分が関与したと考えられた

Thirty-eight patients (61 ureters) with primary vesicoureteral reflux who underwent extravesical antireflux surgery between Jan. 1975 and March 1989 were retrospectively analyzed. The overall postoperative vesicoureteral reflux (VUR) disappeared in 81.6% (31/38) of the patients, 86.9% (53/61) of the ureters. Among patients under 8 years old, VUR disappeared in all but one ureter. The postoperative VUR the disappeared in 95.7% (22/23) of the patients, 97.2% (35/36) of the ureters. Early postoperative early complications, including macrohematuria and bladder irritation were significantly fewer than those occurring in patients treated by the intravesical method. There were no serious late complications. Under restricted indications for patients under 8 years old, extravesical antireflux surgery might be clinically useful for treatment of VUR. Through the re-evaluation of length of submucosal tunnel, surgical outcome of this procedure might be improved.