尿管S状結腸吻合術の再検討 第1報: とくに不成功例の分析

Abstract

Eighteen ureterosigmoid anastomoses were performed for past four years, of which four deaths and two anastomotic failures were experienced. Cause of deaths was recurrence of cancer in one and fecourinary fistula associated with extensive infection due to the anastomotic insufficiency in three cases. In two cases, this insufficiency resulted probably from invasion of carcinoma of the bladder. Two cases of anastomotic failures developed urinary fistulas but were treated by appropriate chemotherapy and nephrectomy. From our experience and literature, the following conclusions might be made. 1) Ureterosigmoid anastomosis is still applicable as one of the permanent urinary diversions because of convenience in social life. 2) When performed after total cystectomy for bladder tumor, the tumor should be removed completely. 3) Prevention of life-threatening fecourinary fistula is a matter of extreme importance. If this developed unfortunately, colostomy, nephrectomy, cutaneous ureterostomy, or ileal conduit have to be considered before severe infection may extend.