尿管S状結腸吻合術の再検討 第2報: レ線学的検討

Abstract

Reappraisal of ureterosigmoidostomy was attempted based on our experience of 18 cases (34 ureters) of Leadbetter's anastomosis. Follow-up excretory pyelography, rectosigmoidography and fistelography to detect intestino-ureteral reflux and ascent of urine up to the upper intestine, residual urine and morphological change of the sigmoid colon were evaluated. IVP showed impaired kidney and ureter of various degree within one month but majority of cases returned to normal or improved in six months. A few numbers of cases neither improved nor changed even after six months. No death due to renal insufficiency was encountered. Method of anastomosis was found to be closely related with occurrence of entero-ureteric reflux, ascending infection and renal impairment. Leadbetter's technique, which we have used, has several points to be improved, because rather high incidence of ascending infection (50 %) was seen despite low incidence of entero-ureteric reflux (one case). Ascent of urine to the upper intestinal tract was not beyond the left flexure in twelve cases and to the right flexure in one case. The residual volume ranged 1/3 to 1/5 of the infused solution of 300 ml. No relationship was observed between the residual urine and acidosis. Postanastomotic morphological changes of the intestine did not seem to cause impairment of evacuation of feces and urine. As conclusion, ureterosigmoidostomy can be widely applied as one of the permanent urinary diversions suitable for long survival. It is, however, important to evaluate many cases radiologically and to improve the anastomotic technique.