Brétheau D, Ponthieu A, Rossi I, Pasquier J
Centre d'urologie Castellane, Marseille.
Prog Urol. 1991 Oct;1(5):871-9.
The renal function of sixty one adult patients was monitored by 99mTc-DMSA renal scan after cystectomy for a malignant tumour followed by ileal conduit urinary diversion. The postoperative follow-up period was 10 years. The stenosis rate of the uretero-ileal anastomosis was 12.8% and the incidence of pyelonephritis was 8% The mean value for overall renal function and for the function of each kidney did not deteriorate significantly (p = 0.1 and p = 0.7, respectively) over time. However, 26% of kidneys evaluated at 1 year and at 5 years showed a markedly decreased uptake on the renogram. In 70% of cases, this decreased uptake was related to the development of stenosis of the uretero-ileal anastomosis or pyelonephritis. Renal function remained stable at 5 years in group A, corresponding to patients with good initial renal function (n = 22, p = 0.07), and in group B, corresponding to patients with poor initial renal function (n = 7, p = 0.9). Similarly, the function of solitary kidneys did not deteriorate over the 5-year postoperative follow-up period (n = 7, p = 0.5). The functional value of the kidneys was therefore not globally altered after ileal conduit urinary diversion. The existence of a mechanical or infectious complication should be systematically investigated in the presence of a deterioration in renal function. DMSA isotope renal scan is a complete, qualitative and quantitative, follow-up examination after this type of urinary diversion.(ABSTRACT TRUNCATED AT 250 WORDS)
61例成年患者在因恶性肿瘤行膀胱切除术后接受回肠代膀胱术，术后通过99mTc-DMSA肾扫描监测其肾功能。术后随访期为10年。输尿管-回肠吻合口狭窄率为12.8%，肾盂肾炎发生率为8%。随着时间推移，总体肾功能及各侧肾功能的平均值均未显著恶化（分别为p = 0.1和p = 0.7）。然而，在术后1年和5年评估时，26%的肾脏在肾图上显示摄取明显减少。在70%的病例中，这种摄取减少与输尿管-回肠吻合口狭窄或肾盂肾炎的发生有关。A组（对应初始肾功能良好的患者，n = 22，p = 0.07）和B组（对应初始肾功能较差的患者，n = 7，p = 0.9）在5年时肾功能保持稳定。同样，单肾的功能在术后5年随访期内未恶化（n = 7，p = 0.5）。因此，回肠代膀胱术后肾脏的功能值并未整体改变。肾功能恶化时应系统检查是否存在机械性或感染性并发症。DMSA同位素肾扫描是此类尿路改道术后一种完整的、定性和定量的随访检查。（摘要截选至250词）
