代用膀胱(Kock pouch,Indiana pouch)施行患者の生活の質(QOL)

Abstract

1)非失禁性代用膀胱(Kock pouch, Indiana pouch)を造設した患者の術後の生活の質(QOL)を調査した。2)81例に106項目の質問用紙を郵送し, 自記式にて60例(74%)の症例より回答をえて分析対象とした。3)1回導尿量は約400mlで約4時間毎に導尿している。夜間導尿回数は1.2回である。4)肉体的健康状態や精神的健康状態はおおむね良好に保たれていた。5)ストーマを見られることを嫌うために, 家族と入浴することは少ないものの, 59%が公衆浴場にも行っていた。6)睡眠時には80%がストーマを気にしていなかった。7)社会生活に関するQOLでは, 交友関係, 運動や趣味においては20～30%の患者に悪影響があったが, 術前仕事をしていた患者の22%が術後仕事を止めていた。術後, 旅行を断念した者は少数であった。8)性生活に関しては, 術後勃起力の低下が著しく, 従って性生活はきわめて惨めであり, 勃起力を維持した術式の応用が望まれた。9)手術と関連した症状として, 皮膚の異常はあまり認められなかった。10)質問用紙中の簡単な説明のみの理解であったが, 再度尿路変更術をしなければならないとすれば, 同じ術式を選択すると答えたのは94%であった

To improve the quality of life (QOL) of patients requiring urinary diversion, various surgical techniques including those employing a continent urinary reservoir (CUR), such as Kock pouch or Indiana pouch, and those using the conventional ileal conduit have been advocated. In this study we asked patients who had undergone a CUR operation to complete a questionnaire, consisting of 106 questions relating to the QOL during the disease-free period. A total of 81 questionnaires were sent out, and 60 (74.1%) CUR patients responded. The average age was 61 and the male to female ratio was 49 to 11. The time elapsed from the operation was 42 months. Twenty-nine questions addressed the patients physical condition and on the whole it was kept in good quality. Because they were unwilling to show their stoma, they were reluctant to bathe together with family members. However, 59% of them went to a public bathhouse (common in Japan). Other physical abilities related to exercise were not significantly hampered by this operation. Eighty per-cent of them were not bothered by having a stoma. Twenty four questions were related to social life. The operation had a bad influence in 20-30% of them concerning their interaction with friends and hobbies. Twenty two percent of the patients who had a job prior to the operation stopped working. Only a few patients abandoned travelling. Concerning their sex life (7 questions), males suffered impotence at a very high rate, but only 26% of the patients lost interest in sex. Symptoms related to the operation (41 questions) were mild. Overall, 94% of the patients would choose the same operation again if it were required.(ABSTRACT TRUNCATED AT 250 WORDS)