尿膜管膿瘍の6例の臨床的検討

Abstract

標記6例の臨床所見, 診断, 治療, 手術所見について検討した.初診時, 全例に下腹部痛及び下腹部腫脹を認め, 2例に38度以上の発熱を認めた.全例がCTもしくはMRIにより診断可能であった.全例に抗生剤治療を行い, 1例は抗生剤のみで画像上腫瘤が消失したため外科的治療は施行しなかった.手術は5例全てに尿管膜全摘術を施行し, 38度以上の発熱があった2例には術前各々経皮的ドレナージと経臍的ドレナージを行った.手術時の炎症の波及程度は経臍的ドレナージ例が一番強く, 腹膜から皮下にまで及んでいた.この症例は術後約1年目に腸閉塞を起こしたが, 保存的治療で軽快した

We encountered 6 patients with pyourachus (male, 1; female, 5) who ranged in age from 17 to 58 years (mean, 41 years) during the 7 years from 1993 to 1999. Three of them had a history of gynecological surgery, and 2 had a history of appendectomy. Improvement was observed in one patient with conservative therapy alone, but the other 5 patients underwent surgery. Preoperatively, 2 patients underwent drainage, one of them through the umbilicus, and the other through a position on the midline percutaneously. Pathological examination in the 5 patients revealed no evidence of cancer. With reference to postoperative complications, adhesive ileus was recognized in 1 case one year postoperatively but no other complications were noted in the other 5 cases. No evidence of recurrence has been seen in any of these patients to date.