Clinical experience of the Kock continent ileal urinary reservoir in 20 cases focusing on complications

Abstract

1986年8月より1990年7月までに, 20例のKock continent ileal reservoirによる尿路変更術を施行した.術後3ヵ月以内の早期合併症として, 創部感染4例, 尿管回腸吻合部からの尿漏出3例, 輸出脚の脱出, 腸閉塞は各2例, 逆流, 尿管狭窄, 回腸吻合不善, 術後膵炎は各1例づつ認めた.晩期合併症としてpouch内結石形成2例, 輸入脚狭窄1例をみたが, この狭窄はDacron collarの部位に認めた.早期10例と後期10例に分け, 各グループの合併症と手術成績を比較検討した.早期10例のうち8例にのべ14例の合併症を認めたが, 後期10例では4例に減少した.症例が増すにしたがって早期合併症は減少し, 手術成績も後期10例の方が早期10例より良好であった.術後水腎症の検討を行ったところ, 術後1, 2ヵ月目では9例に軽度の水腎症が認められたが, 術後3ヵ月以降は5例と, 正常化する傾向が認められた.pouch内に400～500 ml注入時の最大pouch内圧は37.9±12.2 cmH2O (mean±SD)と, 注入に伴う内圧の著明な上昇は認めなかった

From August 1986 through July 1990, 20 patients underwent construction of the Kock continent ileal reservoir and were observed for more than three months. The early complications within the first 3 months were wound infection in four patients (20%), leakage at uretero-intestinal anastomosis in three patients (15%), prolapse of efferent limb and ileus in two patients (10%) and reflux, ureteral stenosis, intestinal fistula and postoperative pancreatitis in one patient (5%). The three late complications included stone formation in two patients and stenosis at an afferent limb in one patient. The stenosis occurred at the position of Dacron collar. The patients were divided into two groups and we compared the recent 10 patients with the initial 10 patients on complications and end results. In the initial group, 8 patients (80%) had 14 complications. In the recent group, 4 patients had 4 complications. The early complications have been reduced with the increase of Kock pouch operation. The result of the recent group was better than that of the initial group. Frequency of postoperative hydronephrosis in patients with Kock pouch was investigated. In nine patients (45%) the minimal hydronephrosis occurred within the first two months and in 5 patients (25%) three months after the operation. It had a normalizing tendency. The maximum pouch pressure at the pouch volume of 400 to 500 ml was not significantly high (37.9 +/- 12.2 cmH2O, mean +/- S.D.).