尿管S状結腸吻合術の再検討 - 第3報 電解質を中心とした検討
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Sixteen patients with ureterosigmoid anastomosis were studied on serum electrolytes and BUN. Experimental study was also carried out on ammonia production in vitro mainly by means of feco-urinary mixture. The following results were obtained. 1) Tendency of hyperchloremia and metabolic acidosis was recognized after ureterosigmoid anastomosis. 2) This condition was proved to be a result of ammonia production from the urinary urea by the intrafecal substance. Ammonia should be then reabsorbed through the intestine in the form of NH4Cl. Urea-splitting microorganisms do not seem to play a role in this process. Renal function also does not seem to be a main cause but only a promoting factor. 3) For treatment and prevention of hyperchloremia and acidosis, we would recommend sufficient water-intake, frequent voiding without leaving residual urine, low salt and low protein diet, and administration of large dosage of sodium bicarbonate. 4) BUN remains as an important indicator of renal function even under ureterosigmoidostomy despite possible reabsorption of the urinary substances. It should be within normal range if renal function is un-impaired. 5) Whenever hyperchloremia, acidosis and azotemia could not be controled by means of conservative treatment, ureterosigmoid anastomosis should be given-up, and urinary diversion of another type should be considered. 6) Serum potassium and sodium did not change significantly in our cases. Hypokalemia, however, should be always kept in mind because of acidosis and polyuria which are frequent after ureterosigmoidostomy.
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