子宮癌,直腸癌根治術後の排尿障害に対する非無菌的間歇的自己導尿法の経験

Abstract

1978年1月から1982年10月までの間に, 直腸癌, 子宮癌根治手術後に排尿障害を認めた35例につき検討した.これらの症例を, 手術直後より自己導尿法を開始した新鮮例(27例)と, 手術後3ヵ月以降に薬物療法が無効などの理由により自己導尿法を開始した陳旧例(8例)に分類した.35例中16例は, 自己導尿法期間中の膿尿発生率が, 20%以下であった.新鮮例のうち6例は, 自己導尿法開始後1週から7ヵ月の間に残尿率が20%以下となり, 自己導尿法より離脱でき, 10例は自力排尿を認めるも, 残尿率20%以上であり自己導尿法を続けている.さらに11例は, 自己導尿法開始後もまったく自力排尿ができない状態であった.新鮮例中の9症例にUP maxを, 自己導尿法開始前と開始後3ヵ月以降の時点で比較したところ, 正常値以下ながら8例に上昇が認められた.新鮮例11例について, 膀胱内圧所見の変化を検討したが, とくに有意な所見は認められなかった

To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.