Kock Continent Ileal Reservoirによる尿路変更術の経験

Abstract

1) 1984年11月より1985年8月までに, continent ileal reservoir (Kock回腸膀胱)による尿路変更術を行ったのは13例である.2)評価しえた10例中, 7例に非常に良好な結果, 2例に比較的良好な結果, 1例は不成功に終わった.3) 9例のパウチの容量は, 平均6ヵ月間の経過観察で300～500 mlとなり, 尿失禁もよくコントロールされ, 患者の満足度も高かった.4)術前腎機能障害のあった1例に軽度のアチドーシスをみたが, 少量の重曹投与により改善できた

We tried the new method of urinary diversion via a continent ileal reservoir, reported by Kock in 1982, and now being accepted with great enthusiasm and satisfaction not only by doctors, but also by patients in Europe and in the United States. With this method, continency with storage of urine under low pressure is well maintained so that no external appliances are necessary. Ileorenal reflux is also prevented with this nipple valve forming technique, minimizing impairment of renal function. We report for the first time in Japan 13 cases, in which this method of innovative urinary diversion was used, with special attention paid to its demanding surgical technique and early results with its complications. From November, 1984 to August, 1985, we performed urinary diversion via the Kock pouch in 13 cases: 10 males and 3 females, from 35 to 67 years old (mean age 49 years), 11 bladder cancer patients, and 2 rectal cancer patients. The 2 patients with rectal cancer died from cancer and 1 bladder cancer patient with psychosis died from mental crisis 4 months after the operation. Of the 10 cases followed up long enough, 7 cases were in excellent condition with complete continence, 2 cases were in good condition with minor leak due to intermittent prolapse of the nipple valve, and in one case with failure, due to the postoperative ileus and eversion of the nipple valve, which made it difficult to catheterize into the pouch. Excision of the pouch and conversion to the standard ileal conduit was performed by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)