Austen M, Kälble T
Department of Urology and Pediatric Urology, Klinikum Fulda, Fulda, Germany.
J Urol. 2004 Sep;172(3):831-8. doi: 10.1097/01.ju.0000134890.07434.8e.
Tumor development following ureterosigmoidostomy is a worldwide accepted late complication. In contrast, tumor risk in other forms of urinary diversion with the separation of urine and feces is still unclear. We present a complete and detailed analysis of all reported tumors following urinary diversions using isolated gut segments in the literature. We estimated the tumor risk in comparison to ureterosigmoidostomies and to the general population.
We reviewed the world literature up to April 2003 via MEDLINE for secondary tumors in urinary diversions using isolated intestinal segments.
We found 81 tumor case reports following urinary diversion using isolated intestinal segments. Tumors developed in 18 conduits, 45 cystoplasties, 5 rectal bladders, 3 neobladders, 6 colonic pouches and 4 ileal ureter replacements.
All urinary diversions using bowel with or without separation of urine and feces carry a significantly higher tumor risk for intestinal tumor development compared to the general population. The tumor spectrum and tumor location in isolated gut segments are different than tumors following ureterosigmoidostomies but the total tumor risk is probably similar. The latency period depends on the initial diagnosis with malignant diseases leading to a shorter induction time. Concerning etiology, many theories exist but the exact mechanism remains unclear. Regular endoscopic control beginning with postoperative year 3 for early detection of secondary malignancies is mandatory.
输尿管乙状结肠吻合术后肿瘤发生是一种全球公认的晚期并发症。相比之下，其他形式的尿液改道（使尿液和粪便分离）的肿瘤风险仍不明确。我们对文献中所有报道的使用孤立肠段进行尿液改道后的肿瘤进行了全面而详细的分析。我们估计了与输尿管乙状结肠吻合术以及普通人群相比的肿瘤风险。
我们通过MEDLINE检索了截至2003年4月的世界文献，以查找使用孤立肠段进行尿液改道后的继发性肿瘤。
我们发现了81例使用孤立肠段进行尿液改道后发生肿瘤的病例报告。肿瘤发生于18个导管、45个膀胱扩大术、5个直肠膀胱、3个新膀胱、6个结肠袋和4个回肠代输尿管。
与普通人群相比，所有使用肠道进行尿液改道（无论尿液和粪便是否分离）的患者发生肠道肿瘤的风险显著更高。孤立肠段中的肿瘤谱和肿瘤位置与输尿管乙状结肠吻合术后的肿瘤不同，但总的肿瘤风险可能相似。潜伏期取决于最初诊断的恶性疾病，导致诱导时间较短。关于病因，存在许多理论，但确切机制仍不清楚。从术后第3年开始定期进行内镜检查以早期发现继发性恶性肿瘤是必要的。
