Dykes E H, Ransley P G
Department of Paediatric Urology, Hospital for Sick Children, London.
Br J Urol. 1992 Jan;69(1):91-5. doi: 10.1111/j.1464-410x.1992.tb15467.x.
We report our experience of gastrocystoplasty in 8 children (mean age 10.1 years) with compromised renal function (mean creatinine 186 mmol/l, mean glomerular filtration rate 39 ml/min/1.73 m2). Current follow-up ranges from 11 to 35 months (mean 21). The physiological outcome of the procedure has been excellent, with improved biochemical and urodynamic parameters in all cases. Six patients are off H2-receptor blockers and are asymptomatic. In 2 children we have encountered significant symptoms related to acid secretion in the bladder. Detailed investigations suggest that the excess aciduria is related to the size of the gastric patch in 1 patient. The second child underwent renal transplantation 5 months after gastrocystoplasty and it is postulated that his immunosuppressive regimen (which includes prednisolone) may be responsible for the increased acid secretion. It is concluded that gastrocystoplasty is a very satisfactory alternative to intestinal segment bladder enhancement in children with compromised renal function, but the size of the gastric patch is critical in determining the resultant acid secretion. Post-transplantation immunosuppressive therapy may increase acid production from the gastric patch; since the children most suitable for gastrocystoplasty are also those likley to require transplantation, this aspect requires further study.
我们报告了8例肾功能受损儿童（平均年龄10.1岁，平均肌酐186 mmol/l，平均肾小球滤过率39 ml/min/1.73 m2）行胃膀胱扩大术的经验。目前随访时间为11至35个月（平均21个月）。该手术的生理结果极佳，所有病例的生化和尿动力学参数均得到改善。6例患者停用H2受体阻滞剂且无症状。在2例儿童中，我们遇到了与膀胱酸分泌相关的显著症状。详细检查表明，1例患者的酸尿过多与胃补片大小有关。第二个孩子在胃膀胱扩大术后5个月接受了肾移植，据推测，他的免疫抑制方案（包括泼尼松龙）可能是酸分泌增加的原因。结论是，对于肾功能受损的儿童，胃膀胱扩大术是肠段膀胱扩大术非常令人满意的替代方法，但胃补片的大小对于确定最终的酸分泌至关重要。移植后的免疫抑制治疗可能会增加胃补片的酸产生；由于最适合胃膀胱扩大术的儿童也是那些可能需要移植的儿童，这方面需要进一步研究。
