膀胱全摘除術後のHemi-Kock代用膀胱の長期成績及びQOL調査

Abstract

1)1990年7月より1993年10月迄に膀胱腫瘍に対する膀胱全摘後のKock式自排尿型代用膀胱症例37例で, その長期成績を検討した. 2)術後3ヵ月の時点で, 35例中32例が, 術後4年以上経過した患者では22例中19例が自排尿のみで管理が可能.自排尿可能な患者のうち殆ど失禁のない例は術後3ヵ月では25/35, 術後4年以上では15/21. 3)術後のパウチに起因した合併症として, 輸入脚滑脱3例・パウチ尿道吻合部狭窄5例及びパウチ内結石2例の10例に計14回の再手術を要した. 4)現在生存中の患者にアンケートを施行したところ, 19例中8例(42%)は排尿状態に不満があるか, QOLが制限されていると答えた. 5)本法は煩雑な術式のため合併症はやや多いが, 排尿状態に関しては長期的に安定している術式と考えられた

We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.