尿管S状腸吻合術による尿路変更の経験

Abstract

Clinical studies were done on 14 patients who had undergone urinary diversion by ureterosigmoidostomy during the past 63 months since Our Hospital started its medical service. The primary diseases were bladder tumor in 12 patients, renal pelvic tumor combined with bladder tumor in 1 patient and paraurethral tumor in 1 patient. All patients underwent radical cystectomy. Ureterosigmoid anastomosis was performed in 15 ureters with Sampson's technique, in 9 ureters with Leadbetter's combined technique and in 1 ureter with Nesbit's technique. The incidence of postoperative pyelonephritis was infrequent in patients who had undergone ureterosigmoidostomy with Leadbetter's combined technique. Immediate postoperative increase in the level of serum BUN was seen in some patients, whereas gradual increase in the level of serum BUN was seen in more patients between 6 and 12 months after operation. Postoperative level of serum Cr was stable. Hyponatremic and hypokalemic tendencies were seen until 6 months after operation. Hypochloremic tendency was seen in the immediate postoperative period, whereas hyperchloremia was frequently seen after 6 months postoperatively. Although a hypocalcemic tendency was seen in approximately one half of the patients in the immediate postoperative period, it later returned to the normal range. Fluctuation of serum P level was similar to that of serum Ca level, but there was transient hypophosphatemia in some patients even after 6 months postoperatively. The level of serum Mg tended to elevate after operation. Hypomagnesemia, however, was seen in I patient who had shown psychiatric disturbances. Sodium bicarbonate ranging in dosages from 2 to 9 g was prescribed for 5 patients who were hyperchloremic. Four of the 14 patients are dead. Recurrence of the tumor as the cause of death was seen in only 1 patient. Of the 10 patients who are alive, 7 are being followed up regularly at our outpatient clinic. Except for occasional development of pyelonephritis in some patients, all 7 are free of serious postoperative complications and are enjoying daily life without external urinary devices.