腎盂尿管移行部狭窄症手術における初回不成功例の検討

Abstract

腎盂形成術を行った腎盂尿管移行部狭窄症23例25腎(男17例, 女6例, 平均15.9歳).術式はAnderson-Hynes法22腎, Y-V plasty, Hellstrom法, simple pelvi-ureterostomy各1腎であった.術後平均8.6年の排泄性腎盂尿管造影による判定で, 水腎症の程度が改善した初回成功例は21腎, 不変及び増悪の不成功は4腎であった.不成功の原因としては, 感染, 尿浸潤, 不適切な縫合による管腔内での肉芽形成を認めた

We retrospectively reviewed the records of 23 patients (25 kidneys) who underwent open pyeloplasty for ureteropelvic junction obstruction (UPJO) between 1980 and 2001, focusing on failures. The patients included 17 men and 6 women, ranging from 3 months to 69 years old (mean 15.9 years). The followup period was 6 months to 19 years (mean 8.6 years). Anderson-Hynes pyeloplasty, Y-V plasty, Hellstrom's operation and simple pelvi-ureterostomy were performed in 22, 1, 1 and 1 kidney, respectively. We successfully repaired 21 of 25 renal units (success rate 84.0%). Of the four patients (4 kidneys) with persistent UPJO occurring in this primary pyeloplasty series, repeat pyeloplasty was performed on 2 patients, nephrectomy on 1 patient and balloon dilatation on 1 patient. Infection and prolonged urinary drainage seem to result in fibrosis of periureteral tissues. Inadequate stitches may cause granuloma in the lumen of the anastomosis. The techniques and complications associated with open pyeloplasty are discussed.