臍部チューブレス両側尿管皮膚瘻術の試み

Abstract

著者らが考案した臍部チューブレス両側尿管皮膚瘻術を, 骨盤内臓器悪性腫瘍の浸潤・再発・リンパ節転移にて根治術不能で, 尿路変向の要する3例に施行した。その結果, 手術時間は115～165分で, 3例すべてにおいて術後早期はチューブレスとなった。1例のみ急性腎盂腎炎, 腎機能障害にて術後1ヵ月でダブルJカテーテルを留置したが, 他の2例は術後9, 2ヵ月と経過は短いもののカテーテルフリーとなっている。尚, 術後合併症は全身的なものはなく, 尿路合併症として急性腎盂腎炎が2例あったが, うち1例は手術が直接原因ではなかった。予後は現在, 3例とも生存中である。

In some patients with intractable symptoms from incurable pelvic cancer, for example, urgency, severe hematuria, fistula formation and hydronephrosis, palliative urinary diversion with intestinal segments may not be available. Percutaneous nephrostomy or indwelling of double-J ureteral stents were usually performed. However, they suffered catheter trouble and their quality of life considerably worsened. Therefore, we developed a new technique of bilateral extraperitoneal tubeless cutaneous ureterostomy with single umbilical stoma. It resulted in symptom relief in 3 patients. The advantage of this method was as follows. The dissection was entirely extraperitoneal. The operative time was short and the procedure could be performed easily. The left ureter need not be led behind the mesosigmoid. Finally, ostomy care was easy with only one bag.