術後13年目に回腸導管に変更したKock pouch造設例

Re-urinary diversion to ileal conduit after 13 years'Kock continent ileal reservoir：A case report

　患者は76歳，男性。62歳時に膀胱腫瘍に対し膀胱全摘除術，Kock pouch造設術を行った。その後Kock pouchに度々トラブルが生じ，今回輸入脚部狭窄症に対し内視鏡的切開を試みるも不可能であり，術後敗血症および播種性血管内凝固症候群をきたしKock pouch摘出回腸導管造設術を行った。Kock pouch造設術は最初に報告された禁制型尿路変向術であるが，合併症と他の優れた術式が存在する現在では主流ではない。

　A 76-year man was admitted to our hospital because of bilateral hydronephrosis due to afferent limb stenosis of his Kock pouch constructed when he was 62 years old. He underwent excision of the Kock pouch and re-diversion to an ileal conduit because of repeated afferent limb troubles and of septic shock and disseminated intravascular coagulation syndrome occurred during the treatment of severe afferent limb stenosis. Difficulties in the treatment of complications associated with urinary diversions were made.（Rinsho Hinyokika 58：327-329,2004）