尿管腸吻合術後の過鹽素血性酸性症に關する臨床的並びに實驗的研究

概要

論文の詳細を見る
(I) Studies of blood pH and serum chloride were made in 25 patients immediately after the uretero-enterostomy. Those patients consist of 3 patients with bilateral uretero-sigmoidostomy, 4 with artificial sigmoid-bladder, 13 with ileumbladder, 3 with uretero-sigmoido-vesico-neostomy, 2 with uretero-ileo-vesico-neostomy, (one of them were Scheele's ring-plastic operation) and 8 with lumbar ureterostomy. In addition, the same studies were done about one year or more after operation in 12 cases, containing 6 of uretero-sigmoido-stomy, 2 of sigmoidbladder, one of caecumbladder and 3 of ileumbladder. The results were as follows : A) Early results after operation a) Evidence of hyperchloremic acidosis was demonstrated in all patients who underwent uretero-sigmoidostomy and in 2 cases of them it was the cause of death with clinical symptome. In 2 of 4 patients with sigmoidbladder, this sign was demonstrated, being of slight degree in one. One of them unaccompanied with this sign, is the patient in whom wet colostomy was performed. In only one of 13 patients with ileumbladder, hyperchloremia developed temporarily. Post-operative course of this operation was perfectly well, that of 8 patients with lumbar ureterostomy being also good. b) The type of uretero-intestinal anastomosis performed does not influence the development of hyperchloremic acidosis, but the type of artificial bladder does. c) In patients with the reconstruction of a part of ureter by substitution of sigmoid segment or ileum segment, blood electrolyte imbalance as a rule did not occur, with only exception of a case of Scheele's ring-plastic operation. In this case hyperchloremia occurred temporarily because urine tends to be retained in isolated ileum-ring. Namely, the reconstruction of a part of the ureter by substitution of bowel segment is a new type of the ureteroenterostomy. d) Hyperchloremic acidosis developed early postoperatively in 19 cases or 34.5%, and hyperchloremia in 23 or 41.8% of 55 cases including all type of the ureteroenterostomy in our clinic. Hyperchloremic acidosis developed in 15 or 53.6% of 28 cases with bilateral ureterosigmoidostomy. These results are almost corresponding with the findings of other authors. B) Late results after operation Hyperchloremic acidosis was demonstrated in 2 and hyperchloremia in one of 6 cases with ureterosigmoidostomy. But in 2 patients, 4 and more 10 years after operation respectively, hyperchloremic acidosis was not demonstrated and they were perfectly well. It is found therefore, that some of patients who underwent uretro-sigmoidostomy can become stable in long course, though this operation has generally poor results. In one of 2 cases with sigmoidbladder, hyperchloremia, was demonstrated, but in one with caecumbladder and 3 with ileumbladder it was not demonstrated. Namely, it is concluded that ileumbladder is in good condition of blood electrolyte on late results as well as on early results after operation. (II) In order to pursuit the cause why ,the blood electrolyte imbalance does not develop in ileumbladder, studies of the electrolyte absorption have been done on such patients and dogs by injecting 1% and 5% sodium chloride solution into the isolated segments of intestine. Samples of the infused solution as well as those of circulating blood were taken at 60 minutes interval to the third hour and the level of chloride recorded. The results were as follows : 1) Chloride is absorbed from the sigmoidal and ileac mucosa and serum chloride increases temporarily. 2) Ileum has a greater ability absorbing chloride than sigmoidcolon. 3) The degree of absorption of chloride from intestine is influenced by the area of intestinal mucosa exposed to the solution, the length of time the solution remains in contact with the surface of intestinal mucosa and the chloride concentration in the solution. 4) Even if a great amount of chloride in urine might be absorbed from the isolated intestine, permanent hyperchloremia does not develop when the renal function is good. 5) Concerning the reabsorption of urine constituents, ileumbladder is not more predominant than the other artificial bladder. Because in ileumbladder the area of isolated ileum is small and urine does not remained for a long time in it, the reabsorption of urine constituents is not so magnificient, though ileum has a great absorptionsability. But some amounts of it are always reabsorbed. 6) The problem of the reabsorption of urine is not the main cause of the stability of electrolyte balance in the ileumbladder.
社団法人日本泌尿器科学会の論文

尿管腸吻合術後の過鹽素血性酸性症に關する臨床的並びに實驗的研究

スポンサーリンク

概要

著者

関連論文

スポンサーリンク