Pickard Robert
School of Surgical and Reproductive Sciences, The Medical School, University of Newcastle upon Tyne, NE2 4HH Newcastle upon Tyne, UK.
World J Urol. 2004 Sep;22(3):227-34. doi: 10.1007/s00345-004-0438-4. Epub 2004 Aug 13.
Patients and their urologists are quite rightly concerned about the possibility of neoplastic change within intestinal segments transposed to the lower urinary tract. This fear arises from the occurrence of latent adenocarcinoma arising from the urocolic anastomosis in approximately 10% of patients who underwent ureterosigmoidostomy in childhood. The present text provides an update of previous reviews and details work published since 1990 on epidemiological, experimental and clinical studies. Consideration of the collected evidence confirms the increased risk of colonic neoplasia following mixing of the faecal and urinary stream by ureterosigmoidostomy or its more recent variants. In contrast, the occurrence of tumours within transposed intestinal segments appears more likely to be related to the underlying urinary tract disease for which the surgery was performed rather than exposure of the intestinal mucosa to urine. This conclusion is, however, based on low level evidence and, despite the reassuring findings, caution is advised until more robust data are available to provide a confident risk assessment.
患者及其泌尿科医生理所当然地关注转移至下尿路的肠段发生肿瘤性改变的可能性。这种担忧源于在儿童期接受输尿管乙状结肠吻合术的患者中，约10%会出现源于输尿管结肠吻合口的潜在腺癌。本文提供了对先前综述的更新，并详述了自1990年以来发表的关于流行病学、实验和临床研究的工作。对所收集证据的考量证实，输尿管乙状结肠吻合术或其更新的变体使粪便和尿液混合后，结肠肿瘤形成的风险增加。相比之下，转移肠段内肿瘤的发生似乎更可能与进行手术所针对的潜在泌尿系统疾病有关，而非肠黏膜暴露于尿液。然而，这一结论基于低水平证据，尽管有令人安心的发现，但在有更有力的数据可提供可靠的风险评估之前，仍建议谨慎行事。
