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末端回腸을 利用한 尿轉流術의 臨床的 考察

A Clinical Evaluation of the Use of an Isolated Loop of the Ileum in Urinary Diversion

대한외과학회지 1969년 11권 8호 p.499 ~ 506
김세호, 羅燾憲,
소속 상세정보
김세호 (  ) - 國立醫療院 一般外科
羅燾憲 (  ) - 國立醫療院 一般外科

Abstract


Clinical observations and evaluations were made on 18 patients, who had a Ureteroileocutaneostomy performed, utilizing the Bricker´s method for urinary diversion at National Medical Center during a 5 year period from January 1963 to February 1968.
Urinary Diversion is to convert the urinary stream into another channel in order to keep urinary continence and the preservation of renal function, as near to normal as possible, particuarly in cases having obstructive lesions of the distal urinary system or congenital anomalies. It has become one of the most important operations in the fields of General Surgery and Gynecology as well as Urology because, 1) there is a greater possibility obstruction by a malignant neoplasm withthe increase of cancer prevalance, and 2) in more radical operations such as pelvic exenteration, this procedure is necessary and mandatory. Urinary diversion by use of an isolated terminal ileal segment was first advocated by Bricker in 1950 when he performed pelvic evisceration in the treatment of advanced cervical cancer.
Of the 18 cases observed, 6 were bladder cancer, 1 was myosarcoma of the bladder, 10 were tuberculosis of the renal system and 1 case of vesico-vaginal fistula. Follow-up studies of these cases were possible, with the exception of 2 cases of malignant tumors which expired within a six months and from 6 months to 3 and half years. The evaluations were mainly based upon pyelographic changes and clinical evidence. Seven cases were combined with total cystectomy and the remaing cases had only urinary diversion without cystectomy.
Complications were classified inot 2 groups; 1) Early (before discharge) and 2) Late(after discharge). There were 8 early complications, which were controlled well with conventional methods of by minor surgical intervention and 9 late complications. Among the latter, cases of progressive hydronephrosis were observed, there could have been derived from progession of the primary disease, but not from the stricture of ureteroileal anastomosis. Among another 3 cases with a hyperchloremic picture, we could not find even one case of acidotic symptoms such as fatigability, weakness, anorexia, salty taste, nausea and vomiting, resulting from abnormal absorption of chloride through the utilized ileum.
The results which were classified into 4 groups, were as follows; Satisfactory 10, Unsatisfactory 2, Insufficient data 4, and expired(before 6 months) 2 cases, there was no operative mortality.
Conclusions are; Urinary Diversion by use of the isolated loop of ileum is great advantage over any of the other methods because Bricker´s method entails less risk of renal damage and hyperchloremic acidosis. Also it is unlikely to cause hydronephrosis because of the lowered pressure in the ileac conduit and less liability of stricture formation in ureteroileal anastomosis.
Therefore, Ureteroileocutaneostomy by Bricker´s method can be safely used as a permanent method of urinary diversion with good results.

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