膀胱腫瘍患者に対する回腸新膀胱の臨床的検討

Abstract

1)回腸新膀胱を20例に施行した.重篤な術後早期合併症はなく, 再手術を施行した症例もなかった. 2)晩期合併症として尿管回腸吻合部狭窄が2例あり, 1例は尿管回腸新吻合術を施行, 1例は内視鏡的に狭窄部を拡張した.回腸新膀胱内結石が2例に発生し, ESWL及び砕石術をそれぞれ施行した. 3)全例が自然排尿可能であり, 夜間尿失禁を認めたものが2例(全失禁)あった.回腸新膀胱過伸展による回腸新膀胱周囲炎が1例あり創部との間に尿瘻を形成した.残尿や回腸新膀胱容量等の定期的チェックと回腸新膀胱に対する十分な教育的指導が重要と思われた. 4)術後の局所再発を2例に認めたが, 尿道再発はなかった

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.