儿童和青少年行可控回肠膀胱术（Kock储尿囊）5至12年后的维生素B12和叶酸水平

Abd-el-Gawa G, Abrahamsson K, Norlén L, Hjälmås K, Hanson E

Department of Pediatric Surgery, Queen Silvia's Children Hospital, Göteborg University, Sweden.

Eur Urol. 2002 Feb;41(2):199-205. doi: 10.1016/s0302-2838(01)00032-x.

OBJECTIVE

To assess B12 and folate deficiency after continent urinary diversion via a Kock continent urinary reservoir in children and adolescents.

METHODS

Ten boys and 10 girls (10.8-18 years old at surgery) were operated with a Kock reservoir and followed for 5-12 years (mean 8.5). The follow-up period was divided into early (3 months-5 years, EFU) and late (5-12 years, LFU) follow-up. Patients were investigated for haemoglobin, serum iron, total iron binding capacity (TIBC), serum Vitamin B12, serum and blood folate, methylmalonic acid (MMA), homocystine and glomerular filtration rate.

RESULTS

Two patients developed subnormal B12 values (median 107.5 pmol/l), one at the EFU, and the other at LFW. The B12 value decreased during the LFU compared to the EFU in nine patients, but it was still within the normal range. Two patients with renal impairment had elevated MMA with normal B12 values. Five patients had high values of homocystine with folate deficiency and/or B12 deficiency and renal impairment. Plasma folate mean value was normal during the whole follow-up. Blood folate was below normal in five patients at the EFU. Two of these five patients, in addition to three patients, had low values at the LFU. Three of four patients with remaining short terminal ileum (20-45 cm) had normal B12 values at both the EFU & LFU and one had low values at the LFU. Six patients had subnormal GFR at the LFU.

CONCLUSIONS

To a similar degree as in adults, Vitamin B12, folate and iron deficiency can occur in children and adolescents after continent urinary diversion using an ileal segment. Therefore, Vitamin B12 and folate should be monitored regularly in these patients. Serum MMA and homocystine may offer increased detection of Vitamin B12 deficiency, especially in the patients with normal renal function. Vitamin B12 deficiency is neither correlated with the time elapsed since surgery, nor with the ileum length. Patients are usually asymptomatic, so patients with true B12 deficiency should be identified and placed on life-long Vitamin B12 therapy. An adequate synthetic folic acid as supplements or fortified food is recommended for patients with folate deficiency.

目的

评估儿童和青少年经Kock可控性尿流改道术构建可控性尿囊后维生素B12和叶酸缺乏情况。

方法

10名男孩和10名女孩（手术时年龄10.8 - 18岁）接受了Kock尿囊手术，并随访5 - 12年（平均8.5年）。随访期分为早期（3个月至5年，EFU）和晚期（5至12年，LFU）。对患者进行血红蛋白、血清铁、总铁结合力（TIBC）、血清维生素B12、血清和血液叶酸、甲基丙二酸（MMA）、同型半胱氨酸和肾小球滤过率的检测。

结果

2例患者维生素B12值低于正常（中位数107.5 pmol/l），1例在EFU时出现，另1例在LFU时出现。9例患者在LFU期间维生素B12值较EFU时下降，但仍在正常范围内。2例肾功能损害患者MMA升高而维生素B12值正常。5例患者同型半胱氨酸值高，伴有叶酸缺乏和/或维生素B12缺乏及肾功能损害。整个随访期间血浆叶酸平均值正常。5例患者在EFU时血液叶酸低于正常。这5例患者中的2例，以及另外3例患者，在LFU时值较低。4例剩余末端回肠长度为20 - 45 cm的患者中，3例在EFU和LFU时维生素B12值正常，1例在LFU时值较低。6例患者在LFU时肾小球滤过率低于正常。

结论

与成人相似，儿童和青少年经回肠段进行可控性尿流改道后可能发生维生素B12、叶酸和铁缺乏。因此，应对这些患者定期监测维生素B12和叶酸。血清MMA和同型半胱氨酸可能有助于提高维生素B12缺乏的检出率，尤其是在肾功能正常的患者中。维生素B12缺乏与手术时间及回肠长度均无关。患者通常无症状，因此应识别出真正维生素B12缺乏的患者并给予终身维生素B12治疗。对于叶酸缺乏的患者，建议补充适量的合成叶酸或食用强化食品。