禁制尿路再建術における逆流防止弁の直視下筋層固定法

STABILIZATION OF ANTIREFLUX INTESTINAL INTUSSUSCEPTION BY MUSCLE BONDING UNDER DIRECT VISION

　いわゆる禁制尿路再建術の成否は逆流防止弁の機能にかかっており，腸重積弁の固定に工夫が凝らされている．著者らは3列の弁内外層縫合固定と，1列の弁外層—弁受容腸管筋層縫合固着を行う術式を導入した．本術式は直視下で容易に行うことができ，また結石の誘因であるstapleを用いないという利点がある．筋層固着による弁固定には信頼性が高く，本術式を採用した8症例の逆流防止弁の機能は良く保持されている．

Stabilization of the nipple valves to prevent reflux and ensure continence is the most important factor in the success of bladder augmentation as well as continent urinary diversion utilizing the bowel segments. The nipple valve should be stabilized by mesenterial detachment, fixation between the outer and inner layers of the intussuscepted valve, and muscle-to-muscle bonding between the valve and the recipient bowel wall. To achieve these principles, we have introduced a new technique for stabilizing the antireflux valves.