二分脊椎症例における膀胱尿管逆流防止術に関する考察

Abstract

二分脊椎患者32例に於いて, VUR(膀胱尿管逆流現象)を有する50尿管に対して逆流防止術を行った。1例を除き全例にCohen法の尿管膀胱新吻合術, 1例に両側Politano-Leadbetter法を行った。平均追跡期間42.5ヵ月に, 尿管の92.0%, 症例の87.5%で成功した。これらの成績は最近の文献のそれ等に匹敵した。3例ではVURが再発した。一側再植え込みを行った別の1例では対側尿管に新しく逆流が発生した。術後VURを防止する為には間欠導尿法を続ける事が重要である事を強調した

A series of 32 patients with spina bifida, representing 50 renal units with vesicoureteral reflux (VUR), was treated with antireflux operation. All but one patient underwent ureteral reimplantation with Cohen's technique. Another patient was treated with bilateral Politano-Leadbetter's technique. The overall success rates were 92.0% by renal unit and 87.5% by case, with a mean follow-up period of 42.5 months. These results were comparable to those in the recent literature. Failure included recurrence of VUR in 3 patients. Another patient who had undergone unilateral reimplantation developed new occurrence of reflux in the contralateral ureter. Possible masking of contralateral VUR should be taken into consideration in patients with unilateral high grade VUR. We also emphasize the importance of continuing clean intermittent catheterization in a proper manner to be free of VUR postoperatively.