尿管S状腸吻合術 : 18症例の臨床的検討

Abstract

1) 1976年より9年間の尿管S状結腸吻合は18例中1例を除きGoodwin法で実施した.2)原疾患は膀胱腫瘍14例, 前立腺癌2例, 女子尿道憩室腫瘍1例および尿道狭窄1例であった.3)術後の血清NaおよびK値はほとんど正常範囲内を変動した.高Cl血症は4例にみられたが, 術後1年以降は比較的安定した経過をたどった.BUNは術後1～2年を経過すると上昇傾向に転じたが, 血清creatinineは正常範囲内での変動であった.4)腎盂腎炎は3例にみられたが, 再発を繰り返すものはなかった.5)排泄性腎盂造影では術後2ヵ月では中等度ないしは軽度の水腎症が18例中9例にみられたが, 多くは1年以内に正常化した.6)排尿は昼間, 夜間ともにほぼ2～3時間に1回の割りであった.尿失禁は夜間熟睡時にのみ2例みられた.7)退院後3例が癌の再発で, 1例は肺炎で死亡した.現在外来通院中の14症例の術後の日常生活は健康人とまったく変わりない.外尿瘻のない本法の排尿状態は充分満足できる

Although various complications such as electrolyte imbalance and urinary infection are known to be induced by ureterosigmoidostomy, it is still a surgical technique difficult to ignore since it allows patients to lead an almost normal life without the encumbrance of external urinary devices. At our hospital, we performed eighteen ureterosigmoidostomy operations between 1976 and 1985. Herein, we review the postoperative conditions of electrolyte, renal function and other complications. The patients (16 male, 2 female) were between 53 and 72 years old, the mean age being 61.5 years. The primary diseases were bladder tumor (14 patients), prostatic cancer (2), carcinoma of the female urethral diverticulum (1) and urethral stricture (1). As to the electrolytes, both serum Na and serum K values fluctuated within the normal range. Hyperchloremia was detected in 4 cases (22.2%), but it was only slightly above the normal range and the conditions were more or less stabilized a year after the operation. Although blood urea nitrogen had a tendency to elevate one or two years after the operation, serum creatinine fluctuated within the normal range. During the observation period, only 7 of the 18 cases (38.9%) showed complications, the major complication being pyelonephritis (3 cases). Postoperative excretory urogram revealed slight to medium hydronephrosis two months after the operation in 9 of the 18 cases (50%), but most of these conditions were normalized within a year. Four patients died after leaving hospital; 3 due to the recurrence of cancer and one due to pneumonia. The 14 other outpatients are enjoying a normal life without the use of any external urinary device.