尿管S状結腸吻合術後の長期合併症に関する臨床的検討

Abstract

1)吻合術は全19例Goodwin法で行った。2)原疾患は膀胱の移行上皮癌17例, 扁平上皮癌2例であった。3)術後の血清Na, K, クレアチニン値はほとんど正常範囲内を変動した。高Cl血症は4例にみられたが術後1年以降は比較的安定した。血清BUNは術後1年で明らかに上昇した。4)腎盂腎炎は4例にみられたが再発はなかった。5)排泄性腎盂撮影では術後2ヵ月では中等度ないしは軽度の水腎症が19例中4例にみられたが多くは1年以内に正常化した。6)尿失禁は夜間熟睡時に2例みられた。7)術後の観察期間は2年2ヵ月より10年2ヵ月で, 平均6年1ヵ月で, 7例は癌死し2例は他病死をした。5年生存率は72.9%であった

Although various complications such as electrolyte imbalance and urinary infections are known to be induced, ureterosigmoidostomy may still prove to be useful on selected patients who desire a continent form of internal diversion. At our hospital, we performed nineteen ureterosigmoidostomy operations in the seven years between 1981 and 1987. Herein, we have reviewed the postoperative conditions of electrolytes, renal function and other complications. The patients (17 male, 2 female) were between 43 and 75 years old, the mean being 60.3 years. The primary disease was bladder tumor with histopathological findings of transitional cell carcinoma (17) and squamous cell carcinoma (2). Post-operative fluctuations in electrolyte values of Serum Na and Serum K were within the normal value. Hyperchloremia was initially detected in four cases (21.0%), but these were only slightly above the normal range and a year after the operations the conditions were stabilized. Although blood urea nitrogen had a tendency to elevate one or two years after the operation serum creatinine fluctuated within the normal range. After the operations, we administered 10% sodium potassium citrate solution to all patients to prevent hyperchloremic acidosis. During the observation period, only four out of nineteen cases (21.0%) exhibited pyelonephritis. No other complications were observed. Postoperative excretory urograms revealed slight to medium hydronephrosis two months after the operation in four out of nineteen cases but most of these conditions were normalized within a year. Nine patients died after leaving the hospital; seven due to the recurrence of cancer and two due to pneumonia. The ten remaining patients are enjoying normal lives without the use of any external urinary device.