Kock回腸膀胱75例の手術成績 : 手技の改良と晩期合併症について

Abstract

最近3年間に経験したKock回腸膀胱による尿路変更75例につき, その手術成績を, 手術手技の改良時期別に検討した.1)本法を施行した75例中, 評価可能な症例は71例であり, うち63例に満足できる最終成績を得た.2)主な術後晩期合併症は, ニップル不全9例と結合形成6例であった.3)ニップル不全の最終手術成績は, CUSA(キャビトロン超音波外科用吸引装置)による腸間膜処置, およびニップルのパウチ壁への固定という二つの改良により, 著しく改善された.4)尿路変更としてKock回腸膀胱は, 手術手技の改善により安全で確実な手術法となり, 廃絶した膀胱を有する患者あるいは膀胱全摘を余儀なくされる患者の生活の質を高める術式と考える

Internal urinary reservoir type urinary diversions have been getting popularity since Kock reported a continent ileal reservoir in 1982. From November 1984 through October 1987, we performed Kock pouch operation in 75 patients (male 64, female 11; from 24 to 82 years old, mean age 56 years old). The underlined diseases were mostly bladder cancer patients; bladder cancer 70, rectal cancer 2, prostatic sarcoma 1, vesical exstrophy 1 and neurogenic bladder 1 case. The end results for 71 evaluable cases, followed up more than 3 months, were excellent in 49 (69%), good 14 (20%), fair 6 (8.5%) and poor 2 (2.8%), with success rate 89%. The most common complication was the nipple malfunction; prolapse, including intermittent prolapse, in 7 patients, slippage or sliding in 1, and eversion in one patient. Stone formation occurred in 6 patients, mild acidosis in 2 and a entero-pouch fistula in a patient who was re-diverted from a ileal conduit. There were 2 deaths postoperatively. Late complications were prominently decreased due to several important modifications of the operative technique, such as usage of Cavitron Ultrasonic Surgical Aspirator (CUSA) for defatting the mesentery, and fixing the nipple to the pouch. In conclusion, Kock pouch can be a safe and sound operative modality for patients who need urinary bladder replacement.