Kock回腸膀胱機能の経時的観察

Abstract

Kock pouchによる尿路変更について, 術後のreservoir機能の変化, 術後の合併症について調べた。1)Pouch容量は経時的に減少する傾向があり, 腸管壁の萎縮等を含む何らかの組織学的変化が生じている可能性が考えられた。2)輸出脚バルブ長は経時的に減少する傾向があったが, 尿失禁との間に相関はなかった。3)Pouchのコンプライアンスは比較的安定しており, 最大容量判定時の内圧も高くなくlow pressure reservoirとして機能していた。4)輸出脚に関する合併症が最も多く, 15例中10例に認められたが再手術を必要としたのは3例であった

Kock continent ileal reservoir has been one of the major options of urinary diversion for the patients with bladder cancer. We performed Kock pouch operation in 16 patients (male 12, female 4; from 41 to 66 years old, mean age 57 years old). Since the reservoir function of Kock pouch after a long postoperative period is not well known, we examined the volume capacity, the compliance and the length of efferent valve of Kock pouch in 8 patients during a 3-year postoperative period. Although the compliance was stable, the volume capacity and the length of the efferent valve showed a decreasing tendency. The shorter efferent valve was not always associated with the case of urinary incontinence. Most of the complications in 15 patients was trouble of efferent valve (prolapse of efferent valve in 7 cases and eversion or fistula formation that required reconstruction surgery in 3 cases). Although some complications were observed, the reservoir function of the pouch was stable. Therefore this method is reliable for permanent urinary diversion.