Triangular Flap Method変法による尿管膀胱新吻合術の臨床的,実験的研究

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The author has treated 21 ureters (19 cases) by the simplified Girgis triangular flap ureterovesicoplasty modified by taguchi. In this simplified method, the sutures between the two margins of the incised transplanted ureters and the two limbs of the V-shaped incision in the bladder floor were carried out by simple interrupted method instead of interrupted horizontal mattress method after Girgis. Long-term results (from 1 to 9 years after operation) of patients with this operation were studied using X-ray examination (IVP and Cystography), renal function tests (PSP, BUN and creatinin) and urinalysis. Furthermore, animal experiments with 20 female adult mongrels were conducted and follow-up studies were made using the above mentioned method and moreover anatomical and histological examination, in order to justify the clinical effectiveness of this simplified method. Following results were obtained: 1) The operative procedures were very simple as compared to the original Girgis method. 2) After this operation a stricture in the region of anastomosis did not occur in any case. 3) In all of the ureters without preoperative VUR (vesicoureteral reflux), it did not occur after the operation. However, in 11 ureters with preoperative VUR, 4 showed VUR even after the operation. 4) In all of the 19 cases, the degree of hydronephrosis and renal function were improved or unchanged. 5) Urinary findings were worsened in 3 out of the 19 cases. 6) From the clinical studies it was noted that this method is contraindicated to the cases with high grade hydroureter and severe inflammatory and edematous changes of the bladder wall. 7) From the animal experiments it was demonstrated that slight or moderate hydronephrosis short after the operation is attributed to the mechanical inflammatory or edematous changes of the terminal ureter. However, these changes disappeared usually 2 months after the operation. From the experimental and clinical studies the author concluded that the simplified method by Taguchi is one of the best method for ureterovesiconeostomy preventing postoperative VUR.
社団法人日本泌尿器科学会の論文

Triangular Flap Method変法による尿管膀胱新吻合術の臨床的,実験的研究

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