Clinical results of tubeless cutaneous ureterostomy by Toyoda's method

Abstract

最近9年間に, 43症例67尿管に対し豊田法により無カテーテル尿管皮膚瘻術を行った.対象患者は男性30例, 女性13例, 平均年齢は61.4歳で, そのほとんどが膀胱, 直腸, 前立腺, 子宮の悪性腫瘍であった.両側性の場合は, 原則として左右尿管を一ヵ所に出す二連銃式尿管皮膚吻合術(double barrel ureterostomy)を行った.術前術後の腎盂像の推移をIVPで追求できた60尿管についてみると, 単側性の場合は20尿管中4尿管を除けばほぼ満足すべき結果を得ている.Double barrel法40尿管について, stoma側では中等度以上の腎盂拡張が20尿管中3尿管であったが, stomaと反対側では腎機能に影響が出ることが多く, 20尿管中3尿管に中等度の腎盂拡張が, また5尿管に高度の腎盂拡張または腎機能喪失があった.術後間もなく汎血管内凝固症候群で死亡した1例を除き, 結果的にはstoma付近が強い炎症性肉芽に覆われた1例と尿管の狭窄を生じた2例を除いた42例中39例(92.8%)をtubelessの尿管皮膚瘻としえた

Tubeless cutaneous ureterostomy by Toyoda's method was conducted in 67 ureters from 43 patients during the last 9 years. Subjects included 30 males and 13 females, with an average age of 61.4 years. Most of them were afflicted with malignant tumors in the bladder, rectum, prostate, or uterus. For bilateral ureterostomy, the double-barrel method was performed in which the stoma was made at the same site in both the right and left ureters. Among 60 ureters in which pre- and postoperative changes in the renal pelvis could be traced by IVP, satisfactory results were obtained in 16 of 20 ureters treated by unilateral surgery. Of the 40 ureters treated by the double-barrel method, moderate or severe pyeloectasis was observed in 3 of the 20 ureters on the side of the stoma, while moderate pyeloectasis was seen in 3 of 20 ureters of the side opposite the stoma, and severe pyeloectasis or loss of renal function was noted in 5. Thus, renal function on the side opposite the stoma was frequently influenced by the procedure. A patient who died of disseminated intravascular coagulation syndrome soon after the operation was excluded from analysis. Tubeless cutaneous ureterostomy could be conducted in 39 of 42 patients (92.8%), excluding one whose stoma and its periphery were covered with severe inflammatory granulation and 2 with ureteral constriction.