尿管S状結腸吻合術の臨床的検討

Abstract

尿管S状結腸吻合術60例を臨床的に検討した.1)原疾患は膀胱腫瘍55例, 子宮癌2例, 萎縮膀胱, 膀胱膜瘻, 尿道狭窄各1例であった.2) DIPでは腎は術1ヵ月後63%は軽度水腎症を呈し, 6ヵ月後うち61%は正常となり, 34%が軽度水腎症を, 5%が中等度水腎症を呈した.3) BUNは術後の経過とともに軽度高値例が多くなり, 術1年後約32%例に上昇したが, いずれも30 mg/dl以下であった.血清クレアチニン値には異常はなかった.血清Cl値は術後上昇傾向をみたが, 重曹の内服でコントロールできた.血清Na, K値には術後変動はなかった.4)術後32%に腎盂腎炎による発熱をみたが, 注腸造影で尿管逆流は認めなかった.5)術後早期合併症16例中10例は尿管腸吻合不全による瘻尿または糞瘻で, 5例は保存的療法で治癒し, 残り5例は手術し, 1例死亡した.早期合併症の死亡は3例であった.6)日常生活上, 夜間頻尿の傾向をみ, 21%に夜間尿失禁をみたが, 96%の患者は外尿瘻のないことに満足していた

Clinical studies were made of 60 patients who had undergone ureterosigmoidostomy at our department. The 45 men and 15 women ranged from 35 to 73 years old, with a mean of 59.2 years. Ureterosigmoidanastomosis was performed using the modified Coffey II technique in this series. Bladder tumor was the reason for the operation in 55 cases, uterine cancer in 2, contracted bladder in 1, vesicovaginal fistula in 1 and urethral stricture in 1. In the excretory pyelogram one month after the operation, normal findings and slight hydronephrosis were observed in 37% and 63% of the patients, respectively. However, the pyelogram 6 months after the operation demonstrated normal findings in 61% of the patients, slight hydronephrosis in 34% and moderate hydronephrosis in 5%. None of them showed severe hydronephrosis. Slightly increased BUN level (less than 30 mg/dl) was seen in 15 out of 45 patients (32%) at one year after ureterosigmoidostomy. However, serum creatinine level was not above normal throughout the postoperative course. Although postoperative hyperchloremia was appreciably detected, it was easily managed by the administration of sodium bicarbonate. Serum sodium and potassium levels remained stationary. Of 35 patients observed for more than one year after operation, 11 patients (31%) had developed fever due probably to pyelonephritis, but sigmoidography failed to demonstrate any ureteral reflux. Either urinary or fecal fistula, a complication in the early postoperative period, occurred in 10 patients (17%). One of these patients died. Five patients were cured by conservative treatment. The remaining 4 patients underwent surgical treatment that was ureterocutaneostomy , nephrectomy, or colostomy.(ABSTRACT TRUNCATED AT 250 WORDS)