回腸導管症例における123I-ヒップラン・シンチグラフィーによる上部尿路検索,ことに回腸尿管逆流症の診断

Abstract

膀胱全摘出術・回腸導管造設をおこなった27例, 52腎につき, 123I-ヒップラン・シンチグラフィー(経時的シンチグラムと局所レノグラム)を施行し, 上部尿路と回腸導管の尿流動態から機能評価をした.腎全体, 皮質, 腎盂, ループ各関心領域より, 局所レノグラムを求め, 定性的に解析したところ, 皮質機能が正常なもの33腎(63.5%), 腎盂機能の正常なもの22腎盂(45.8%), ループ機能が正常なものは14ループ(51.9%)であった.上部尿路の異常所見中, 腎盂尿管の排泄遅延, 尿流停滞を示すものが一番多く, 17腎盂(35.4%)に認めた.腎盂曲線とループ曲線の重ね合わせから, より生理的な条件下での回腸尿管逆流症の診断をし, 27例中22例に認めた.逆流側は両側3, 右側12, 左側7であった.逆行性ループグラムでは施行15例中14例に逆流をみ, 両側性は8例であったが, ヒップラン検査では, 両側性逆流は1例のみで, 5例は1側性, 2例には逆流を認めなかった

To evaluate upper urinary tract and ileal loop functions, dynamic urinary flow studies using I-123 hippuran were performed in 52 kidneys of 27 patients with ileal loop urinary diversion. Analysis of regional renograms enabled easy assessment of the cortical, pelvic and loop functions. Normal pattern was found in 33 cortices (63.5%), 22 pelvis (45.8%) and 14 loops (51.9%). Most of the abnormal findings in the upper urinary tract were delayed excretion and/or retention of the pelvic and ureteral urines. Diagnosis of ileoureteral reflux under normal physiological circumstances was made to compare the pelvic and loop curves. Small peaks and/or irregular spike waves observed in the down slope of the pelvic curve concurrently with the increased activity of the loop curve indicate a production of the ileoureteral reflux associated with ileal movement. This reflux was noted in 22 of the 27 cases (81.5%). Bilateral reflux was evident in 3 cases, and unilateral reflux in 19 cases. Ileoureteral reflux was noticed in 14 of the 15 cases (90%) in which retrograde loopography was performed. Although bilateral reflux was found in 8 cases, the hippuran study revealed bilateral in only one case, unilateral in 5 and no reflux in 2. Thus, I-123 hippuran scintigraphy consisting of sequential renal images, loopograms and regional renograms enables the diagnosis of ileoureteral reflux and obstructive uropathies and is a useful tool to detect functional complications of the upper urinary tract in patients with ileal loop diversion.