尿管・腸吻合 : 自験例の成績と問題点

Abstract

The clinical results of 107 cases, in which uretero-intestinal anastomosis has been performed during past 9 years, were analyzed as to postoperative upper urinary tract, intestinoureteral reflux, whether a splint catheter used or not and postoperative complications. In 67 cases out of 107, mainly one of the three types of operative techniques was employed for the uretero-colic anastomosis with or without the splint catheter; 1) Goodwin method, 2) Seromuscular folding technique, 3) Cordonnier method. Kerr-Colby or Warwick method was also applied in only a few patients. In other 40 cases, direct mucosa-to-mucosa anastomosis according to Cordonnier was used for the uretero-ileal anastomosis without splint catheter. Kerr-Colby method was also employed, but in only a few cases. The results obtained were as follows: 1) Concerning the cases of uretero-colic anastomoses, postoperative IVP revealed predominant result in Goodwin method. Cordonnier method or seromuscular folding technique was rather satisfactory but postoperative hydronephrosis had developed in 22 per cent, 34 per cent respectively. Reflux from bowel into the ureter was almost prevented by the method of Goodwin or seromuscular folding. Cordonnier method was successfull in preventing reflux in 82 per cent. There seemed to be no apparent difference between the cases with and without splinting in the result of postoperative IVP. Various complications associated with ureterocolic anastomosis such as urinary leakage, severe anastomotic stricture, temporary false anuria had been observed in 11 patients. All these complications occurred in the cases without the splint catheter. 2) In the cases of uretero-ileal anastomoses, the postoperative IVP showed good result in 72 per cent, fair in 12 per cent, poor in 16 per cent. Intestino-ureteral reflux was detected in almost a half of the anastomoses. Severe anastomotic strictures were seen in 2 patients but other type of postoperative complications was not observed.