膀胱尿管新吻合術に関する臨床的検討 第1報: primary VUR 65例(100尿管)の手術成績

Abstract

65例, 100尿管のprimary VURに逆流防止手術を行った.1)手術成功率はPolitano-Leadbetter法にて100%, Lich-Gregoir法にて85.7%, 他法は成功しており, 全体で100尿管中99尿管, 99%であった.早期合併症としてVURの残存が1例1尿管に, また片側VUR例にて術後対側にVURの出現をみたものが3例に認められたが, 経過観察中に全例消失している.晩期合併症としてLich-Gregoir法にて尿管膀胱吻合部に尿管狭窄が1例1尿管に出現し, 再手術を必要とした.2)術前に腎盂腎炎もしくは不明熱として治療されていた症例が92%存在したが, 術後腎盂腎炎の発生は16%に減少をみた.3) VURのgradeと水腎症の関係は初期の段階, つまり可逆性があると考えられる時点で必ずしも一致しないが, 高度化した段階では相関する傾向がみられる.4) IVP上の腎盂腎杯の変化では術後1ヵ月の時点で一過性に悪化する症例が26.3%に存在したが, 3～6ヵ月の経過観察にて改善をみた.軽度水腎症はほとんどが6ヵ月以内に正常化するが, 高度水腎症は不変の症例が多かった

We have experienced 72 patients with primary vesicoureteral reflux (VUR) during the past 16 years. Sixty-five of them (100 ureters) were treated surgically to prevent reflux. Among the surgical methods employed, the Politano-Leadbetter method was the most frequent, being used in 56 patients (87 ureters). Other methods were the combined method in 2 patients (three ureters), the Glenn-Anderson method in 1 (2 ureters), the Cohen method in 1 (1 ureter) and the Lich-Gregoir method in 5 patients (7 ureters). As postoperative complications in the early stage (within 1 month after surgery), remaining VUR in 1 ureter in 1 of the patients who underwent surgery by the Politano-Leadbetter method and occurrence of VUR on the contralateral side in 3 patients with unilateral VUR were encountered. These conditions disappeared during the follow-up period. On the other hand, in the late postoperative stage, ureteral stenosis requiring further surgery occurred in 1 ureter in the transitional region to the urinary bladder in 1 patient 2 months after surgery by the Lich-Gregoir method. The rate of success was all 87 ureters (100%) for the Politano-Leadbetter method and 6 out of 7 ureters (85.7%) for the Lich-Gregoir method. The success rates for the other procedures were also good, resulting in an overall rate of 99 out of 100 ureters (99.0%). Ninety-nine percent of the patients had been treated at least once preoperatively for pyelonephritis or fever of unknown etiology. Among these patients, those who had had 5 or more such episodes accounted for 39%.(ABSTRACT TRUNCATED AT 250 WORDS)