第40回 日本泌尿器科学会中部総会シンポジウム 膀胱癌の治療進歩・V. 非失禁型尿路変向術の現況について

Abstract

1) GURが導入されて以来, 浸潤膀胱癌全摘に伴う尿路変更で全体の45%にCURが選択されている.2) Kock pouch 100例の成績からみると, 術後比較的早期にみられる輸出脚合併症は手術手技の改良で克服できたものの, より長期の観察でカラーに起因した輸入脚合併症と結石形成が増加している.3) Indiana pouch 30例の成績からみると, ileal patch法の方がHeineke-Mikulicz法よりも安定した成績を挙げており, CURの第一選択と考えられる.4)ハンモック法による回腸尿管吻

Continent urinary reservoirs (CUR) have become one of the major options of urinary diversion for invasive bladder cancer patients who require cystectomy and cutaneous urinary diversion. We have experienced 100 cases of Kock pouch and 30 cases of indiana pouch during the past 5 years which comprise 45% of all cases. Standard ileal conduit and ureterocutaneostomy were performed in 34% and 20%, respectively, and orthotopic urinary reservoir by hemi-Kock pouch was done in only one case during the same years. There were 3 perioperative deaths, 2 had Kock pouch and one Indiana pouch. Early postoperative complications were not substantial. However, significantly high rates of late postoperative complications were seen in Kock pouch, i.e., both efferent (18%) and afferent (13%) nipple valves and stone formation (18%). Uretero-ileal anastomosis by hammock method done in 10 cases resulted in success in 8 cases, abolishing the afferent nipple. Indiana pouch, in which no nipple valves or foreign materials like staples or collars are necessary, has been adopted as a first choice for the past 3 years. Of 29 evaluable cases, Heineke-Mikulicz method was used in 7 cases, and ileal patch method in 22 cases. An hourglass-like deformity was seen in 2 cases in the former method. Severely difficult catheterization, parastomal abscess, and acidosis occurred in one. Overall, 24 cases (83%) have come up with satisfactory results with minimal overflow incontinence in the early postoperative course. Although much longer followup is necessary, CUR's by Kock or Indiana pouch are more acceptable by bladder cancer patients requiring cystectomy.