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Title   방광암 환자에서 방광 전적출술 후 비실금성 요로전환술의 경험 ( Continent Ileal Reservior After Radical Cystectomy For Bladder Tumor )
Publicationinfo   1991 Jan; 023(02): 366-375.
Key_word   Continent ileal reservoir, Bladder tumar
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Abstract   An ileal reservoir procedure has been performed on 30 patients at our hospital from Jan. 1987 to Aug. 19B8 as a continent urinary diversion after radical cystectomy for bladder tumor. The operating procdure was carried out according to Skinner modification of Kock method initially and according to our minor modification subsequently. There was no operative mortality. There were 4 early complications (13%) resulting directly from this kind of diversion: urinary leakage from ureteroileal anastomosis site, incontinence and reflux. The functional chsracteristics of continent ileal reservoir were studied during 1 year foflow-up period. The capacity of reservoir was 200 ml just postoperatively, which increaaed to 450 ml at 3 months, to 750 at 6 months but did not increased thereafter. Low reservoir pressure without involun- tary spike was recognized in most patients except in 2 patients where involuntary spike above 20 cmH20 were noticed in cystometry, but did not related to incontinence. There were no reflux or ttue incontience by fluoroscopic examination, but in 2 patients partial incontinence occured when urine volume exceed 200 mL Twenty three patients were followed for long term period (19-50 months, mean 28.5 months). Among them, 12 patients (52%) showed no complication. They catheterized 4 ta 5 times a day without difficulty. The peak pressure of reservoir was less than 10cmHD and there were no reflux or incontinence. They lived withaut restrictions in social activity, travelling, bathing and swimming. Seventeen complications occurred in remaining 11 patients (48%) such as partiaf or total incontience, difficult catheterization and urinary retention, reflux, hydroureteronephrasis, multiple stones in reservoir, fistula between the skin and ileal reservoir and urinoma. Vrine culture showed many organisms in all and 2 patients experienced pyelonephritis. The early operative result and the functianal characteristics of continent ileal reservoir indicate that it provides a urine storsge function with adequate capacity and without incontinence and reflux. Most patients appreciate better quafity of life by not having collecting device. But in long term fallowup, the complications which limit the function of reservoir and required reoperation are increased. The patient selection is important to operate this procedure.
저 자   이은식(Eun Sik Lee),이종욱(Chong Wook Lee)