マインツパウチ術後合併症の検討 : とくに導管口狭窄対策についての検討

Abstract

1)1992年12月から1998年1月迄にMainz pouchによる尿路変向手術を30例に施行した. 2)術後6ヵ月以降の晩期合併症のうち処置を必要としない観察可能な水腎症は2例, 処置を要するものは3例であった. 3)ストーマ狭窄による, 導尿困難症例に対しては, 週1回前後の定期ブジーを施行していたが, 虫垂in situ embedding法で3例, 漿膜筋層剥離重積法での2例, 計5例に瘻孔ストッパー(腎瘻ボタン)の装着を試み導尿困難症状の改善をみた. 4)ストーマ狭窄に対しての瘻孔ストッパーの使用は, 患者のQOLから考えて有効な方法と考えられた

Thirty patients underwent Mainz pouch construction between December 1992 and January 1998. The post-operative observation period varied from 6 to 57 months (average, 38.5 months). A mechanism to ensure urinary continence was provided in 24 cases, while formation of a nipple valve by intussusception of the ileum with seromuscular stripping and submucosally embedded in situ appendix was performed in 6 cases. An umbilical stoma was adopted in all cases. Late-phase complications included 3 cases of hydronephrosis requiring treatment. Efferent limb of the stoma was observed in 8 cases, 6 of which were attributable to mild constriction of the stoma at the site of anastomosis of the navel cavity. In those cases in which stomal stricture occurred, difficulty in withdrawing urine was eliminated by providing a fistula stopper. Although few clinical methods to deal with stomal stricture have been reported, we found the fistula stopper to be useful providing good external appearance and patients' quality of life.