Roth S, Cipolla B, Guille F, Lévêque J M, Lobel B
Centre Hospitalier Universitaire de Rennes, Pontchaillou, Service d'Urologie.
Prog Urol. 1991 Dec;1(6):973-86.
During the past several years there has been increasing interest in refunctionalizing patients who have undergone radical extirpative surgery for pelvic malignancies and patients with dysfunctional bladders. To accomplish this, intestinal segments have been successfully employed in a variety of configurations. Independent of their optimal urosurgical implementation these procedures are not without potential complications, a significant portion of which involve metabolic derangements. Besides first follow-up results of patients with bladder substitution or continent urinary diversion, analysis of experimental investigations and functionally comparable clinical conditions enables an insight into potential following physiopathological interrelationships. These concern, besides the problem of chronic metabolic acidosis, disorders of bile acid and vitamin B12 metabolism as well as the potential induction of a secondary hyperoxaluria with subsequent oxalate concrement diathesis. Furthermore, there may be a malabsorption of calcium and vitamin D with development of intestinal osteopathy due to the reduction of absorptive surface. Apart from these problems of enteral loss and deficiency manifestations, several case reports and investigations suggest that bone demineralization can occur as a consequence of chronic metabolic acidosis and patients are at risk of skeletal demineralization. The pathogenesis of this association has yet to be clarified. These physiopathological interrelationships must be considered in medical attendance of patients with intestinal substitute bladders and continent supravesical pouch systems over many years. As these procedures become more popular, it becomes important to identify any metabolic changes that may occur as their consequence.
在过去几年中，对于接受盆腔恶性肿瘤根治性切除手术的患者以及膀胱功能障碍患者进行功能重建的兴趣日益浓厚。为实现这一目标，肠段已成功应用于多种构造。无论其在泌尿外科的最佳实施方式如何，这些手术并非没有潜在并发症，其中很大一部分涉及代谢紊乱。除了膀胱替代或可控性尿流改道患者的首次随访结果外，对实验研究和功能类似的临床情况进行分析，有助于深入了解潜在的生理病理相互关系。这些关系除了慢性代谢性酸中毒问题外，还涉及胆汁酸和维生素B12代谢紊乱以及继发性高草酸尿症的潜在诱导及随后的草酸盐结石素质。此外，由于吸收表面积减少，可能会出现钙和维生素D吸收不良，并发展为肠道骨病。除了这些肠内丢失和缺乏表现的问题外，一些病例报告和研究表明，慢性代谢性酸中毒可能导致骨质脱矿，患者存在骨骼脱矿的风险。这种关联的发病机制尚待阐明。在对使用肠道替代膀胱和可控性膀胱上袋系统的患者进行多年医疗护理时，必须考虑这些生理病理相互关系。随着这些手术越来越普遍，识别可能因手术而发生的任何代谢变化变得很重要。
