Hafez Ashraf T, McLorie Gordon, Gilday David, Laudenberg Bernd, Upadhyay Jyoti, Bagli Darius, Khoury Antoine E
Divison of Urology, Hospital of Sick Children, University of Toronto, Ontario, Canada.
J Urol. 2003 Oct;170(4 Pt 2):1639-41; discussion 1641-2. doi: 10.1097/01.ju.0000083887.58315.7e.
We evaluated the long-term effects of ileocystoplasty on linear growth, serum electrolytes, acid-base profile and bone mineral density (BMD) in a group of neurologically intact children with a mean followup of 8.9 years.
Between 1988 and 1997, 9 girls and 16 boys with a mean age of 6 years (range 1 month to 14 years) underwent ileocystoplasty for etiologies other than myelomeningocele and neuropathic bladder. Indications for ileocystoplasty were small noncompliant bladder secondary to bladder exstrophy in 12 cases, bladder outlet obstruction in 10 and post-partial cystectomy for rhabdomyosarcoma in 3. All patients underwent clinical evaluation, supine height measurement, serum electrolytes, arterial blood gases and BMD measurement using a fan beam dual energy absorpitometry scan. BMD was measured at L1-L4 and corrected for age and sex.
Followup ranged from 4 to 13 years (mean 8.9). Serum creatinine was normal in 20 of the 25 patients. All patients had normal supine height measurement with a mean of 45th (+/- 9) centile on growth charts. Serum electrolytes, calcium, phosphorus and arterial blood gases were normal in all patients. Mean BMD corrected for age and sex was 89 (+/- 10)%. BMD was normal in 17 of 25 (68%) patients. Mild reduction in bone density between 1 and 2 standard deviations below the age/sex mean was documented in 3 (12%) patients and the remaining 5 (20%) showed marked osteopenia of 2 or more standard deviations. Of the latter 5 patients 2 had increased serum creatinine, 1 had a history of radiotherapy for pelvic rhabdomyosarcoma and 2 had cloacal exstrophy and short bowel, all of which might have contributed to the osteopenia.
Ileocystoplasty for children with normal kidney function is not associated with alterations in serum electrolytes or arterial blood gases in the long term. However, 32% of patients showed variable degrees of reduction in BMD. Although marked reduction in BMD was associated with cofactors, 12% of patients had evidence of mild osteopenia in absence of those cofactors. We recommend routine preoperative and longitudinal followup BMD measurements for children undergoing intestinal bladder augmentation.
我们评估了回肠膀胱扩大术对一组神经功能正常儿童的线性生长、血清电解质、酸碱平衡状况及骨密度（BMD）的长期影响，平均随访时间为8.9年。
1988年至1997年间，9名女孩和16名男孩（平均年龄6岁，范围1个月至14岁）因脊髓脊膜膨出和神经源性膀胱以外的病因接受了回肠膀胱扩大术。回肠膀胱扩大术的适应证包括：12例膀胱外翻继发的小容量顺应性差膀胱、10例膀胱出口梗阻以及3例横纹肌肉瘤部分膀胱切除术后。所有患者均接受临床评估、仰卧位身高测量、血清电解质、动脉血气分析以及使用扇形束双能吸收法扫描进行骨密度测量。在L1-L4测量骨密度，并根据年龄和性别进行校正。
随访时间为4至13年（平均8.9年）。25例患者中有20例血清肌酐正常。所有患者仰卧位身高测量均正常，在生长图表上的平均百分位数为第45（±9）百分位。所有患者血清电解质、钙、磷及动脉血气均正常。校正年龄和性别后的平均骨密度为89（±10）%。25例患者中有17例（68%）骨密度正常。3例（12%）患者骨密度轻度降低，低于年龄/性别均值1至2个标准差，其余5例（20%）显示明显骨质减少，降低2个或更多标准差。在这5例患者中，2例血清肌酐升高，1例有盆腔横纹肌肉瘤放疗史，2例有泄殖腔外翻和短肠，所有这些因素可能都导致了骨质减少。
对于肾功能正常的儿童，回肠膀胱扩大术长期而言与血清电解质或动脉血气改变无关。然而，32%的患者显示出不同程度骨密度降低。尽管明显的骨密度降低与一些辅助因素有关，但12%的患者在无这些辅助因素的情况下有轻度骨质减少的证据。我们建议对接受肠道膀胱扩大术的儿童进行术前常规和长期随访骨密度测量。
