膀胱尿管新吻合術に関する臨床的検討 第2報: Boari法8例,Psoas-Hitch法8例の手術成績

Abstract

膀胱尿管新吻合術を行う場合, 尿管が短い症例に対しBoari法8例, Psoas-Hitch法8例を施行した.1)術式の選択に関しては初期の4例には粘膜下トンネルを作成しないBoari法を行ったが, 後期はBoari法とPsoas-Hitch法を選択して施行してきた.膀胱を総腸骨動静脈上方まで伸展でき, 尿管が粘膜下トンネルを作る余裕のある症例に対してはPsoas-Hitch法を行い, 尿管に余裕のない他の症例に対してはBoari法を行った.2)初期に行ったBoari法の2例とPsoas-Hitch法の1例にVURを認めた.尿管狭窄は全例に存在しなかった.3)水腎症はほとんどが改善もしくは不変であり, 腎機能においても術後異常を認める症例は存在しなかった

Vesicoureteroneostomy was performed by Boari's method on 8 patients and the psoas-hitch method on 8 patients during the 16 years from 1969 to 1986. Although Boari's method without the formation of a submucosal tunnel was employed for the initial 4 patients, the formation of this type of tunnel was a general principle for all patients thereafter. In choosing the surgical method, the psoas-hitch method was assigned to patients in whom it was possible to extend the urinary bladder to the upper part of the common iliac vessel and in whom the ureter allowed the formation of a submucosal tunnel, and Boari's method was assigned to those in whom it is was not possible to reach the ureter or to form a submucosal tunnel or in whom the ureter would be tensed. The mean length of the resected section of ureter was 75 mm for Boari's method and 43.2 mm for the psoas-hitch method. Follow-up observations revealed the presence of VUR in 2 patients who underwent surgery by the initial form of Boari's method and in 1 patient who underwent surgery by the psoas-hitch method. There was no ureteral stenosis or renal hypofunction in any of the patients.