凝固因子製剤とフィブリン接着剤で治癒せしめた難治糞瘻

INTRACTABLE FECAL FISTULA CURED BY A COMBINATION OF CONSERVATIVE THERAPY USING FIBRIN ADHESIVE AGENT AND COMPLICATING

　71歳，男性。1984年9月13日，膀胱腫瘍の診断にて膀胱全摘・回腸導管造設術を施行した。術後，重篤なイレウスを合併，対症療法にて改善したが，創部ドレーンより糞便の排泄を認めた。瘻孔造影にて回腸皮膚瘻を形成していた。禁食，IVHによる治療を試みたが，瘻孔の閉鎖は認めなかった。術後4年目，瘻孔の治療の目的にて血液凝固第XⅢ因子製剤を投与後，間隔をおいてフィブリン接着剤の局所注入を行ったところ瘻孔の完全治癒を得た。

A 71-year-old man was admitted to our hospital with diagnosis of invasive bladder cancer. Total cystoprostatectomy, regional lymphadenectomy and ileal conduit of urinary diversion were performed on September 13, 1984. Intractable fecal fistula was complicated postoperatively communicating with ileum. The patient was administrated with intravenous-hyperalimentation under nothing per os to achieve oc-clusion of the fistula but leakage continued. On May 24, 1988, fecal fistula was retreated conservatively using fibrin adhesive agent locally following the administration of coagulation FactorⅩⅢ -concentrate and complete cure was obtained