Kälble T, Möhring K, Waldherr R, Staehler G
Abteilung für Urologie, Universität Heidelberg.
Helv Chir Acta. 1992 Oct;59(3):507-11.
The increased risk of colon carcinoma following urinary diversions via colon makes knowledge about preneoplastic changes necessary. In 30 ureterosigmoidostomy patients with a mean observation period of 16 years flexible sigmoidoscopy with biopsies and nitrosamine analysis of the feces/urine mixture have been performed. In the biopsies we found an increased sialomucin concentration at the ureterocolonic anastomosis in 29.2%--sialomucin is supposed to be a preneoplastic change--with no significant difference to the mucosa periureteral and in the rectum. In 58.3% we found chronic inflammation at the anastomosis, in 29.2% periureteral and 4.2% in the rectum. 2/30 patients developed adenocarcinoma, 1 patient an atypia and 1 patient a juvenile polyp. The nitrosamine excretion of the ureterosigmoidostomy patients were significantly increased compared to 20 healthy controls with no correlation to the histology at the anastomosis or the observation time. Because of the multilocular presence--colon carcinomas develop only at the anastomosis--sialomucin and chronic inflammation seem to be no preneoplastic changes in urinary diversions. The nitrosamine analysis is not suitable for routine follow-up as well.
通过结肠进行尿路改道后结肠癌风险增加，因此有必要了解癌前病变情况。对30例输尿管乙状结肠吻合术患者进行了平均为期16年的随访，期间进行了可弯曲乙状结肠镜检查并取活检，同时对粪便/尿液混合物进行了亚硝胺分析。在活检中，我们发现29.2%的患者在输尿管结肠吻合处唾液酸黏蛋白浓度升高——唾液酸黏蛋白被认为是一种癌前病变——与输尿管周围黏膜和直肠黏膜相比无显著差异。58.3%的患者在吻合处发现慢性炎症，输尿管周围为29.2%，直肠为4.2%。30例患者中有2例发生腺癌，1例出现异型增生，1例出现幼年性息肉。与20名健康对照相比，输尿管乙状结肠吻合术患者的亚硝胺排泄量显著增加，且与吻合处组织学或观察时间无关。由于结肠癌仅在吻合处发生且呈多灶性，唾液酸黏蛋白和慢性炎症似乎并非尿路改道中的癌前病变。亚硝胺分析也不适用于常规随访。
