Indiana pouchの晩期合併症と手技の改良

Abstract

1) 1987年10月より1991年9月までにIndiana pouchによる尿路変更手術を39例に施行した.2)この間に, 結腸の完全なdetubularization, stapled plication, U-shaped ileal patch法などの手技の改良を行った.3)早期合併症は開放手術に共通する一般的なもので, continent urinary reservoir (CUR)に直接関連したものはなかった.4) 3ヵ月以上経過観察された37例の晩期合併症のおもなものは, pouch変形(2例), 導尿困難(2例), ストーマ狭窄(2例), アシドーシス(1例)などであった.5) 90%以上の症例で良好な尿のコンチネンスがえられ, 尿管への逆流を認めたものはなかった.6)本術式は, 術式が比較的簡単で重大な合併症も少ないことから, 今後もきわめて有用なCURであると考えられた

From October, 1987 through September, 1991, 39 patients underwent construction of Indiana pouch for cutaneous urinary diversion. There were 35 men and 4 women, and their ages ranged from 38 to 77 years (a mean age of 62 years). After the first 8 cases, Indiana pouch was constructed with several modifications which included complete detubularization of the cecum, construction of the pouch augmented with U-shaped ileal patch, and the use of stapled plication. There was no major early complication related to the pouch but one postoperative death of blood transfusion related graft versus host disease. End results were evaluated in 37 patients who were followed for 3 to 49 months. Late complications related to urinary reservoir occurred in 8 patients. The early two patients experienced pouch deformity due to incomplete detubularization of the colonic segment. Two patients had difficult catheterization due to a dilatation of the plicated ileum. One patient had metabolic acidosis requiring hospitalization. Patients perform self-catheterization 4-5 times during the day and 0-2 times at night for volumes ranging from 300 to 1, 000 cc. Of 37 patients 34 achieved acceptable urinary continence and one had significant leakage requiring cutaneous bag. The remaining two patients suffered mild nocturnal incontinence. Follow up examination with excretory urography showed no upper urinary tract obstruction except one with unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy showed no reflux into the upper urinary tract in all the follow up cases.(ABSTRACT TRUNCATED AT 250 WORDS)