回腸導管造設術 : 後ケアーの諸問題

Abstract

回腸導管造設術施行症例180例について検討した. 1)術後早期合併症, 晩期合併症の発症率は, それぞれ33.3%, 31.6%であった. 2)晩期合併症のうち最も発症率の高いストーマ周囲皮膚炎に対する, 医師のより積極的な関与が心要である. 3)晩期合併症のうち, 尿管回腸吻合部狭窄及び尿路結石症に対しては, endourologyを用いた積極的な治療が有用である. 4)術後QOLに関するアンケート調査では93%の患者が現状に満足していたが, ストーマ, 採尿袋などのbody image及び尿漏れ, 尿臭などが社会活動を制約している事実も確認された

A series of 180 patients treated with ileal conduit urinary diversion at Nara Medical University and its affiliated hospitals were reviewed. The patients ages at the time of operation ranged from 21 to 79 years old with an average of 60.9 years old and the average postoperative follow-up period was 44.2 months. Early complications occurred in 60 patients (33.3%) and 9 (5.0%) of them resulted in post-operative deaths. Late complications were noticed in 54 (31.6%) of the 171 patients. Frequent late complications included peristomal dermatitis (37.3%), ureteroileal stenosis (17.9%) and urolithiasis (11.9%), for the latter two of which endourological treatments seemed to be effective. To be emphasized is that more attentive care should be paid to the condition of the peristomal skin during follow-up.