肛門括約筋内結腸瘻を併用せる直腸膀胱術 : II 自験症例の成績とその検討

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Forty-four patients underwent an operation for rectal bladder combined with intrasphincteric perineal colostomy during the past 8 years. Of these, 20 were operated by Lowsley-Johnson procedure, 11 by Staehler's, 12 by Duhamel-Boissonnat procedure, and the remaining one by Heitz-Boyer Hovelacque procedure. Thirty-seven patients had a malignant disease. The results are given below. 1) Early mortality (within 30 days of operation) was 6.8% (3 cases), and late mortality (beyond 30 days) was 22.7% ( 10 cases) . The latter was always due to carcinomatosis. 2) The most frequent complication that had developed in both early and late postoperative courses was pyelonephritis. Hyperchloremic acidosis with manifest clinical signs was noted in 3 patients (7.3% ) and was transient. 3) TAree different techniques mentioned in our preceding paper were used for ureteral implanta-tion, and the results of these three were compared one another. Patients were followed by periodic excretoty urography (IVP) and retrograde rectosigmoidography. The findings in this study suggest that the cause of upper urinary tract infections after construction of an isolated rectosigmoid bladder is urinary stasis due to stricture of the ureter at the anastomosed site, rather than intestino-ureteral reflux. Ac-cordingly, the authors believe that mucosa-to-mucosa anastomosis is the most reliable technique for ureteral implantation. 4) Urination in the postoperative course was nearly satisfactory, but bed wetting was recorded in 18 cases (51.5%), including 5 ( I 5.2%) who suffered every night, of the 35 patients who were successfully followed up. 5) Restoration of defecating function was described. From the point of view of this function, the "retroanal (-rectal) sigmoid pull through" is advantageous over other techniques. In pulling through the sigmoid colon, one must pay attention not to damage the puborectal sling. 6) One half the patients undergoing this operation returned to preoperative activities. Of these, all the patients with benign disease returned succesfully to their work.
社団法人日本泌尿器科学会の論文
1974-11-20

肛門括約筋内結腸瘻を併用せる直腸膀胱術 : II 自験症例の成績とその検討

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