非失禁型尿路変向Florida pouchの経験

Abstract

1)手術時間は平均9時間4分と長く, 術前の充分の排便処置やOlssonらの吸収針4列装填自動縫合器の導入などにより時間短縮をはかる必要がある。2)パウチ増設直後の容量は90～180mlと小さいが, 3ヵ月後には3倍以上となり, ほぼ満足すべき管理状況である。3)導管の長さは原法では10cmであったが, 回盲弁をその両脇から的確に縫縮すれば8cmでも尿禁制を保つことが可能である。4)合併症は早期には腹壁ヘルニア2例, 導管壊死1例がみられ, 前者は13因子欠乏が主因と思われた。晩期では尿管パウチ吻合部狭窄が2尿管, パウチ尿管逆流現象が1尿管に見られた

From October 1990 through June 1993, the Florida pouch, a continent urinary reservoir using the ascending colon and the dexter half of the transverse colon was constructed in 7 patients after cystectomy for invasive tumor. Concerning the length of the efferent limb, although 10 cm was adopted in the first three cases, we shortened it and finally considered 8 cm to be the adequate length. Although the capacity of the reservoir ranged from 90 ml to 180 ml immediately after operation, an increase of capacity by three times or more within three months after operation was seen. The patients performed self-catheterization 4-5 times during the day and 0-2 times at night for volumes ranging from 300 to 600 ml. Continent colonic urinary diversion did not appear to create either any significant acid-base changes or azotemia in patients with normal renal function. Every patient received both a serum value evaluation and an absorption test for vitamin B12 (Schilling test). Although there were no patients with a reduced serum vitamin B12 level, one patient showed a slightly low absorption value. Because there is a large quantity of vitamin B12 reserve in the liver, it must be emphasized that even when the entero-hepatic circulation has been injured by surgical interruption of the intestinal tract, it may be years before reduced serum vitamin B12 value become apparent. Accordingly, the vitamin B12 absorption test should be performed regardless of the ileal length incorporated into the resection.