直腸癌術後の神経因性膀胱

Abstract

直腸癌根治術後, 尿流体力学検査を含めた諸検査を行い, 外来にて尿路管理を行っている患者48例をretrospectiveに解析した.1)リンパ節郭清の程度が大きいほど, 間歇的自己導尿から自排尿への移行は困難であった.2)低位前方切除術後の71.4%, Miles手術後の51.9%が間歇的自己導尿を離脱し, 自力排尿へ移行しえた.3)強い排尿困難を合併した症例でも, 間歇的自己導尿の早期導入により術後数ヵ月すればカテーテルの助けを借りることなく, 腹圧排尿が可能になる症例が多く, この移行は術後1年以内に集中した.4)最高尿道閉鎖圧は, 自排尿可能(catheter free)群, 間歇的自己導尿群ともに低下していた.5)直腸癌根治手術の術後排尿障害をきたした場合, 自己導尿法を中心とした治療は現在のところ有効な手段である

Of the patients who had had a urodynamic examination during the five year period from 1982 to 1987 in our clinic, 48 patients underwent operations for rectal cancer prior to the study. In 35 of them, the operation mode was known. If the pelvic nerve is damaged by operative modes for rectal cancer, urinary disturbances of severe kinds may occur. In spite of such disturbances, 71.4% of those who had had excision of the low anterior part and 51.9% of those with Miles' operation could be weaned from the clean intermittent self-catheterization and take up spontaneous urination. Even in patients who developed severe dysuria, if catheterized at an early stage, many of them could urinate by abdominal pressure with in several months after operation, without the aid of a catheter. This transition took place mostly within one year after operation. When a patient develops dysuria after radical surgery for rectum cancer, treatment mainly with self-catheterization is an effective method at present.