回腸導管造設術々後13年目に発症した導管狭窄の1例

Abstract

63歳男.膀胱腫瘍の為膀胱全摘除術及び回腸導管造設術を施行され, 術後3ヵ月毎に経過観察を受けていたが, 術後13年目の超音波検査で両側水腎症を指摘され, レノグラムで両側の排泄遅延を認め, 検査及び治療目的で入院となった.画像所見より導管狭窄と診断され, 24Fr拡張バルーンカテーテル及び12Frバルーンカテーテルを用いて導管狭窄拡張術を施行した.カテーテル抜去後順行性造影では導管遠位部まで描出された.術後3年経過現在, 腎盂拡張は認めず, レノグラムでも両腎とも排泄は良好である

A 63-year-old male was admitted to our hospital with the complaint of bilateral hydronephroses. Total cystectomy and ileal conduit construction were performed because of bladder tumor (TCC, G2, pT2N0M0) in 1985. The patient remained asymptomatic, but bilateral hydronephroses was observed by ultrasonography in 1997. DTPA renogram showed the delayed excretion. Conduitgraphy and antegrade pyelography revealed that the conduit was narrow like a pinhole at 2 cm distal region from the anastomotic site of the urinary duct. The stenotic region was inflated by a 24 Fr inflation-balloon-catheter. Chronic inflammation, which was thought to be caused by infection, was detected at the stenotic conduit by biopsy. Hydronephroses disappeared after the operation and the postoperative course was uneventful.