膀胱全摘除術における術後合併症および予後に関して

Abstract

5年間に膀胱全摘除術をおこなった患者27例の術後合併症および予後について検討した.1)術後合併症に関しては多くの症例に対しかなり積極的な手術をおこなったにもかかわらず諸家の報告と比べてさほど遜色のないものであった.2)予後に関してはいまだに経過観察期間が充分でない, また手術療法とくに根治術における適応の決定が必ずしも充分ではなかったなどのことより満足すべきものではなかった

Clinical studies on postoperative complications and prognosis were done on 27 patients who had undergone cystectomy at our hospital. Thirty one postoperative complications were seen in 16 patients. Early complications which developed within 3 months of operation were more frequent (25 cases). They included pyelonephritis (5 cases), wound infection (4 cases), pulmonary complications (2 cases), cardiovascular complications (2 cases), ileus (2 cases) and delayed ambulance (2 cases) in decreasing order of frequency. Complications related to urinary diversion were observed in 4 out of 6 late complications. Reoperation secondary to surgical complications were done in 6 cases. Four of the 6 reoperations were related to gastrointestinal complications, all of which would be fatal if left untreated. Postoperative followup period ranged from 3 weeks to 49 months with a mean period of 12.8 months. The present status of the patients is as follows: 16 patients alive, 10 patients dead and 1 patient lost to followup. So far we cannot draw a definite conclusion regarding the relationship between surgery and the prognosis of the patients because the followup period is too short in many patients. In our experience: 1) The fewest cancer deaths occurred in patients who had undergone radical surgery; 2) the largest percentage of living patients was seen in the group of patients who had undergone radical cystectomy; and, 3) almost all patients with low stage tumors are living more than 6 months after operation.