泌尿器科手術におけるValtracを用いた腸管吻合

Abstract

膀胱全摘除術後の尿路再建の際, 10例でValtracを腸管吻合に用いた.原疾患は膀胱腫瘍が8例で, 神経因性膀胱が1例, 膀胱に浸潤したS状結腸癌が1例であった.吻合の種類は回腸回腸が8例, 回腸上行結腸が2例であった.縫合不全や吻合部からの漏れを起こした例はなかった.術後15日目及び16日目に3例が軽度閉塞を経験し, 嘔吐がみられたが, 保存的療法で速やかに軽快した.これら以外には, 術後1ヵ月～1年(平均7.3ヵ月)の観察期間中に腸閉塞症状を呈した例はなかった

Valtrac, a biofragmentable anastomosis ring, was used in 10 patients who underwent total cystectomy and urinary tract reconstruction. The primary disease was bladder tumor, neurogenic bladder, and sigmoid colon cancer invading the bladder in 8, 1, and 1 of the patients, respectively. There were 8 ileo-ileostomies and 2 ileo-colostomies. No patient developed anastomotic leakage or insufficiency. Symptoms of mild bowel obstruction were observed in 3 patients, but they improved with conservative management. The outcome was good in all the patients without further ileus during a follow-up period of 1 to 12 months (median: 7.3 months). The most important advantage of this device is that precise bowel anastomosis is standardized and can be achieved safely and quickly. Our findings indicate that the Valtrac system offers a reliable and reproducible alternative to conventional anastomotic techniques in urologic surgery.