Roux-y乙状结肠新膀胱替代后肠黏膜组织学变化及对代谢的影响(英文)  

Histological change of reservoir mucosa and effect on metabolic state in patients with a Roux-y sigmoid neobladder

作　　者：夏维木[1] 刘定益[2] 王名伟[3] 周文龙[4] 王健[2] 徐玉生[1] 张立[1] 马春曦[1] 陈荣剑[1] 叶永峰[1] 

机构地区：[1]解放军第一八四医院泌尿外科,江西省鹰潭市335000 [2]上海市浦东新区浦南医院泌尿外科,上海市200125 [3]上海交通大学医学院附属瑞金医院卢湾分院泌尿外科,上海市200025 [4]上海交通大学医学院附属瑞金医院泌尿外科,上海市200025

出　　处：《中国组织工程研究与临床康复》2009年第31期6193-6196,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：Medical Science and Technology Research Planning Program in Nanjing Military Area Command of Chinese PLA during "Eleventh Five-Year" Period, No. 06MA80~~

摘　　要：背景:许多报道指出,尿流改道后会出现代谢紊乱和病理生理的变化,但是这些用肠道重建膀胱替代手术引起的代谢紊乱主要与肠管类型及长度相关。目的:观察Roux-y乙状结肠新膀胱替代后贮尿囊黏膜的变化及对代谢的影响。设计、时间及地点:回顾性病例分析,于2000-06/2008-11在解放军第一八四医院泌尿外科完成。对象:33例膀胱癌患者,男21例,女12例,平均年龄64岁。对照组为25例经胃肠镜活检无乙状结肠疾病史者。方法:采用根治性膀胱全切、利用肛门括约肌控尿的Roux-y乙状结肠新膀胱术进行手术治疗膀胱癌患者,分析新膀胱引流管拔管前后血电解质、肌酐和尿素的变化,并对其中13例患者的贮尿囊黏膜于术前、术后36个月取材作病理学检查。对照组为25例无乙状结肠疾病史者乙状结肠黏膜。检测项目包括肠黏膜厚度及腺体数目。主要观察指标:手术前、拔管前后电解质、肾功能和酸碱平衡、黏膜层厚度、腺体数目。结果:30例患者术后血电解质、肌酐和尿素均保持在正常范围,拔管前后电解质、肌酐和尿素的变化差异无显著性意义,3例患者表现有轻度的酸中毒。对照组手术前后结肠黏膜镜下改变不明显,基本保持了正常的组织结构。手术组术后黏膜层厚度变薄[(577.6±169.4),(412.5±114.7)μm,P<0.05],肠腺排列疏松,间质稀少,单位腺体数目减少[(26.4±3.5),(15.2±2.7)个/HP,P<0.05]。术后新膀胱内的肠绒毛逐渐萎缩,肠上皮细胞未见增生及恶性改变。结论:Roux-y乙状结肠新膀胱替代后肠黏膜层厚度变薄,肠腺排列疏松,间质稀少,单位腺体数目减少,人体代谢无明显变化。BACKGROUND： Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion. But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal. OBJECTIVE： To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobiadder. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Urinary Surgery, the 184 Hospital of Chinese PLA between June 2000 and November 2008. PARTICIPANTS： The experimental group comprised 33 bladder carcinoma patients, 21 males and 12 females, averaging 64 years of age. The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy. METHODS： Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter. Prior to and after neobladder drainage tube removal, serum levels of electrolyte, creatinine, and urea nitrogen were detected. Before and 36 months after surgery, reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined. For the control group, the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined. MAIN OUTCOME MEASURES： Electrolyte, renal function, acid-base balance, mucosal layer thickness, numbers of intestinal glands prior to and after surgery, as well as prior to and after drainage tube extraction. RESULTS： After surgery, electrolyte, creatinine, and urea nitrogen were all normal in 30 patients. There was no significant difference in serum electrolyte, creatinine, and urea nitrogen between prior to and after surgery. Mild acid poisoning was found in 3 patients. Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery, and it basically kept the no

关 键 词：尿流改道 膀胱切除 乙状结肠新膀胱 代谢 

分 类 号：R589[医药卫生—内分泌]