3歳女児に施行せる尿管・回腸・S状結腸吻合術の経験

Abstract

Ureteroileosigmoidostomy, a sort of internal urinary diversion, was performed for a 3-yearold girl, who previously had a total cystectomy and bilateral cutaneous ureterostomy because of rhabdomyosarcoma of the urinary bladder and had been attacked by repeated urinary tract infection associated with mild bilateral hydronephrosis. The convalescence of the ureteroileosigmoidostomy was uneventful and postoperative urograms revealed no evidence of urinary stasis. Contrast medium enema showed ureteral reflux to the left upper urinary tract. Three weeks after the operation, however, she had a severe anorexia with deteriorated acid-base balance, but the administration of alkalizing agents was effective and was continued. During the post-operative follow up period of 9 months, there was no evidence of pyelonephritis and no hazards in daily life. Her growth rate was somewhat slow compared with that of normal Japanese children, but we had no impression of emotional disturbance with her. After the detailed case report, several advantages of ureteroileosigmoidostomy were discussed under following stand points. 1. Ureteroileal anastomosis seems to be more satisfactory compared with ureterosigmoidal anastomosis if a nonobstructive anastomosis is more desirable than an anastomosis without ureteral reflux. 2. The interposed ileum segment can be expected to act as a functional valve against pressure gradient between ureter and sigmoid colon. 3. Effectiveness of the ileal segment as a bacteriological barrier between the upper urinary tract and the lower intestinal tract cannot be completely ignored.