尿管損傷の臨床的検討

Abstract

6例(男2例)において, 損傷側は右側1例, 左側5例, 損傷部位は腎盂尿管移行部1例, 血管交差部よりも下部5例であった.原因は医原性損傷が5例で外科及び婦人科の骨盤内手術時に発生し, 1例は鈍的外傷により発生した.4例は術中に診断され, 1例は術後の尿漏れ, 1例は腎盂腎炎を契機にそれぞれ診断された.尿管尿管吻合術は2例, 腎盂尿管吻合術は1例, 尿管膀胱新吻合術(膀胱壁を腸腰筋に固定した)は1例, Boari膀胱弁法は1例, 単純縫合は1例に行った.5ヵ月～7年8ヵ月の追跡では, 癌肉腫再発による死亡1例を除き, 全例で腎機能は温存されている

Six cases of ureteral injuries were analyzed. Two cases were male and 4 cases were female. The right side was affected in 1 case and the left in 5 cases. The affected portion was the uretero-pelvic junction in 1 case and lower iliac vessels in the other cases. Five cases were iatrogenic injuries in surgical or gynecological pelvic operation, and the other was due to blunt trauma. Intraoperative diagnosis was made in 4 cases. Drain leakage led to diagnosis in one case and pyelonephritis in another. Ureteroureterostomy was performed in 2 cases, pyeloureterostomy in 1 case, ureteroneocystostomy with psoas hitch in 1 case, Boari bladder flap in 1 case and simple suture in 1 case. 4-0 or 5-0 Dexon with an atraumatic needle was used for all anastomoses. Except for case 1, who died of the recurrence of carcinosarcoma, renal functions were preserved in all patients during the follow-up period ranging from 5 months to 7 years 8 months.