Kock 回腸膀胱による尿路変更術 - 合併症と問題点について -

Abstract

Kock continent ilcal urinary, reservoir (Kock回腸膀胱)による尿路変更術22例の手術経験をもとに, その手術成績, 手術手技, および問題点を中心に述べた.1) 22例の現在の状態は, 非常に良好な結果を得ているもの19例, 比較的良好な結果1例, 死亡が2例である.死亡の原因はそれぞれ心不全, 下腸間膜動脈血栓であった.2)術後早期合併症の重篤なものは, 急性腎不全1例, 小腸瘻1例であった.3)術後晩期合併症では, 輸出脚nipple valveの翻転・脱出が1例にあり, 修復手術が施行された.他に, pouch回腸瘻1例, イレウス1例, 軽度水腎症が2例にみられた.4)全例とも, 尿失禁はなく, 腎への逆流も認めていない.5)術後1年以上経過した症例の平均pouch容量は600～700 mlで, 1日の導尿回数は4～6回であった.6)術後の腎機能は術前とほとんど変化がなく, また明らかな代謝異常も認めていない

From May 1985 through July 1987, 22 patients underwent Kock continent ileal reservoir for urinary diversion. There were 19 males and 3 females, between 38 and 82 years old (mean age 63.1 years). A one-stage radical cystectomy and Kock pouch construction were performed in 21 patients. One patients was converted from standard ileal conduit to this new reservoir. The keys to success of the Kock pouch are creation and maintenance of the nipple valve to prevent reflux and to ensure continence. Mesenteric fat is removed with CUSA for 8 cm along the afferent-efferent limbs of the pouch and exclusion of mesentery is limited for only 3-4 cm. This important modification will ensure adequate ileal intussusception and vascular supply to the valves. To prevent eversion and prolapse, the nipple valve is anchored to the wall of reservoir. A strip of sauvage filamentous Dacron serves as a collar to fix the afferent-efferent limbs to the pouch. There were 2 postoperative deaths and two major early complication: 1 acute renal failure and 1 intestinal fistula, both of which were treated conservatively. Late complications occurred in 6 patients. Of these 6 patients, 1 required reoperation and revision of the continence valve mechanism and 1 required hospitalization for entero-pouch fistula. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 4-6 hours during the day and once at night for volumes ranging up to 1, 000 ml. The end result in 19 of 20 patients was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)