失禁型尿路変向術 : 尿管皮膚瘻術,回腸導管,結腸導管

Abstract

1)尿管皮膚瘻(31例)は主に高齢者, high risk症例, 根治性のない浸潤癌症例に施行された.術後のストーマ狭窄の頻度は高く, 63.5%にカテーテル留置を要した.又, 急性腎盂腎炎の発症頻度も高かった. 2)回腸導管(101例)と結腸導管(107例)の比較では, 前者に急性腎盂腎炎や尿路結石の発生頻度が高かった.しかし, イレウスや腸管吻合不全には差はなかった. 3)導管造影を施行したところ, 回腸導管では66.7%に導管尿管逆流を認めたが, 結腸導管では1.3%に逆流を認めたに過ぎなかった. 4)術後の腎機能は, 結腸導管で最も良好に保たれ, 尿管皮膚瘻では低下する傾向がみられた

During the past 20 years, 31 ureterocutaneostomies (UC), 101 ileal conduits (IC) and 107 colonic conduits (CC) were performed. In the UC group, most of the patients were aged or had unresectable invasive pelvic malignancies. The operative mortality was 6.5% and acute pyelonephritis was noted frequently (48.3%). Stomal stenosis also developed significantly (63.5%). The operative mortalities in the IC group and CC group were 6.9% and 9.3%, respectively. Although the incidences of bowel obstruction, bowel fistula and renal calculi were higher in the IC group (18.8% vs 7.5% and 6.9% vs 0%, respectively). The serum creatinine level was lowest in the CC group (0.90 +/- 0.46 mg/dl) and highest in the UC group (1.36 +/- 0.75 mg/dl). Conduit ureteral reflux was frequent in the UC group (66.7%) but rare in the CC group (1.3%). We conclude that UC should be indicated in the selected patients with high risk, and IC and CC are indicated in patients who may have good prognosis but not indicated for continent reservoir or neobladder. We prefer CC in the younger group.