Kock回腸膀胱およびIndiana pouchの臨床的検討

Abstract

1987年7月～1988年11月の間にkock回腸膀胱造設を39～76歳の11例(K群), 1989年7月～1991年3月の間にIndiana pouch造設を44～66歳の9例(I群)に行った.I群の最初の4例にileal patch変法, 後の5例にHeineke-Mikulicz法を行った.一期的根治的膀胱摘出兼尿路変更を19例に行い, 1例で両側尿管皮膚瘻からkock回腸膀胱に変えた.周術期死亡はないが, 各群の各1例でパウチ縫合不全に対し再手術を行った.K群では, 輸出脚の弁不全の1例に輸出脚形成術を行い, 又, 輸出脚脱出を2例, 輸入脚の弁不全を2例にみた.I群では, 1側水腎症を1例, カテーテルの挿入困難を4例にみた.両群の3例で軽度の失禁をみたが, パウチ容量は500 ml以上で, 腎機能もquality of lifeも良い

Recently, the continent urinary reservoir which provides the patient with a better quality of life has become popular. Many types of reservoirs have been reported, but the optimal procedure remains to be established. From July 1987 through November 1988, we performed Kock pouch construction on 11 patients (ages 39 to 76 years). Between July 1989 and March 1991, 9 patients (ages 44 to 66 years) underwent Indiana pouch operation. The first 4 patients underwent ileal patch type, and the subsequent 5 underwent Heineke-Mikulicz type procedure. A one-stage radical cystectomy and continent urinary reservoir construction was performed on 19 patients, and bilateral cutaneous ureterostomy was converted to Kock pouch in one patient. There were no perioperative deaths, but reoperation was required for urinary leakage from the reservoir on one patient in each group. As the late complications in the Kock pouch group, one patient required revisional operation of the continent valve mechanism, 2 patients experienced intermittent prolapse of the nipple valve of the efferent limb, and 2 had malfunction of the afferent nipple valve. In the Indiana pouch group unilateral hydronephrosis was noticed in one patient, and 4 had mild difficulty of catheterization. Although 3 patients in both groups had mild urinary leakage, all patients had good quality of life with capacity of reservoir over 500 ml and with good renal function. We changed the type of operative procedure from Kock pouch to Indiana pouch because of the high complication ratio in the former.(ABSTRACT TRUNCATED AT 250 WORDS)