腎盂尿管移行部狭窄に対する腎盂形成術の手術成績 Anderson-Hynes pyeloplastyを中心に―

Abstract

1) 1963年より20年間に, 奈良県立医科大学泌尿器科学教室および関連病院において腎盂形成術をおこなった35腎の臨床的観察および術後成績について, 排泄性腎盂造影であきらかな改善を認めたものは67.6%, レノグラムで改善を認めたものは66.6%, 自覚症状および臨床症状の改善を認めたものは93.0%で, そのうちAnderson-Hynes pyeloplasty施行例(27腎)ではさらに良好な成績であった.2) Anderson-Hynes pyeloplasty施行例において術後成績と年齢, 術前の尿路感染症の有無, スプリントカテーテルおよび腎瘻管の設置期間, 術後の尿路感染症の持続期間, さらに腎瘻管の設置期間と術後尿路感染症の持続期間の関係について検討した.年齢と術後成績では10歳以下においてもっとも術後の改善度が高かったが, 他の年代に比べて有意ではなかった.術前の尿路感染症の有無, スプリントカテーテルおよび腎瘻管設置期間と術後成績の間には一定の関係は認めなかった.術後16日以内に腎瘻管を抜去しえた症例においては, 術後の尿路感染症の改善および腎機能の改善がきわめてよかった

Thirty-three patients (thirty-five kidneys) underwent pyeloplasty for hydronephrosis due to obstruction of ureteropelvic junction between 1963 and 1982 in our department. Renal function was judged to have improved in 68 and 67% of the patients from the radiogram and radioisotope renogram, respectively, Anderson-Hynes pyeloplasty was performed on 27 kidneys. In these kidneys, the improvement of renal function as judged from the radiogram and radioisotope renogram was 74 and 71%, respectively. Postoperative results were compared according to age, preoperative urinary tract infection (UTI), indwelling periods of nephrostomy and splint catheter, and duration of postoperative UTI. In addition the relationship between indwelling periods of nephrostomy catheter and the duration of postoperative UTI are discussed. Infants under 10 years old had the best improvement. Preoperative UTI and indwelling periods of nephrostomy and splint catheter were not directly related with post operative results. The cases with nephrostomy catheter which could be removed within the 16th day after operation had excellent improvement on UTI and also in renal function.