逆流防止手術合併症, とくに腹腔内臓器貫通損傷について

Abstract

VURの逆流防止手術471尿管につき, 手術合併症の検討をした.特に, Politano-Leadbetter法(PL法)417尿管の経験から, 稀な合併症である尿管の腹腔内臓器貫通損傷例につき臨床的検討を加えた.損傷発生の素地, 臨床経過予防策ならびに修復手術の予後について考察を加えた.なお, 著者等は, 現時点において, 原発性VURの手術術式としては, 必ずしもCohen法を選択するものではないが, 続発性VURで尿管膀胱吻合術を行なう場合にはCohen法はPL法に優ると考える

Unusual complications of the Politano-Leadbetter ureteral reimplantation technique are reported in four ureters in three children with primary vesicoureteral reflux (VUR). These ureters were found to pass through an adjacent intraperitoneal viscus including the sigmoid colon, ileum or broad ligament. This complication occurred in 0.48% of the Politano-Leadbetter antireflux operations for primary VUR. Viscus perforation occurred only in children with a relatively high grade VUR. The prognoses of the hydroureter after ureteric reimplantation or ureterolysis, were good in all cases. Although there are several advantages in the transvesical procedure of the original Politano-Leadbetter method, we should not hesitate to go extravesically if there are difficulties in mobilizing the ureter or inducing it into the vesical cavity.