Stelzner M, Phillips J D, Saleh S, Fonkalsrud E W
Department of Surgery, UCLA School of Medicine 90024.
J Surg Res. 1990 Jun;48(6):552-6. doi: 10.1016/0022-4804(90)90229-u.
Nephrolithiasis occurs in 5 to 13% of patients with ulcerative colitis (UC) who undergo colectomy and abdominal ileostomy, presumably from chronic dehydration and urinary concentration. Whether endorectal ileal pullthrough with ileal reservoir (PTR) changes the incidence of stones (primarily calcium oxalate) after colectomy is not known. Urinary excretion of Na2+, K+, Ca2+, Mg2+, phosphate, urate, oxalate, and citrate was measured in a prospective study of 12 UC patients undergoing PTR with temporary end ileostomy. Twenty-four-hour urine samples were obtained before colectomy (t1), after colectomy but before ileostomy closure (t2), and 5 months after ileostomy closure (t3). Urine volumes decreased from 831 +/- 101 cc (mean +/- SE) at t1 to 715 +/- 101 cc at t2 and then increased to 1278 +/- 421 cc at t3 (significant, with P less than 0.01 by t test). Urinary excretions of Mg2+, oxalate, and citrate were low in UC patients compared to those in controls (15 healthy adult volunteers). Excretion of Ca2+ increased significantly following temporary ileostomy while excretion of Mg2+ fell. Excretion of Ca2+ fell and excretion of Mg2+ and citrate increased following PTR. We conclude that PTR patients have increased urine volumes and urinary ion changes known to decrease the risk of developing renal stones.
在接受结肠切除术和腹部回肠造口术的溃疡性结肠炎（UC）患者中，肾结石的发生率为5%至13%，可能是由于慢性脱水和尿液浓缩所致。采用回肠储袋直肠内回肠拖出术（PTR）是否会改变结肠切除术后结石（主要是草酸钙结石）的发生率尚不清楚。在一项对12例接受PTR并进行临时回肠造口术的UC患者的前瞻性研究中，测量了尿中Na2+、K+、Ca2+、Mg2+、磷酸盐、尿酸盐、草酸盐和柠檬酸盐的排泄量。在结肠切除术之前（t1）、结肠切除术后但回肠造口关闭之前（t2）以及回肠造口关闭后5个月（t3）采集24小时尿液样本。尿量从t1时的831±101毫升（均值±标准误）降至t2时的715±101毫升，然后增至t3时的1278±421毫升（差异有统计学意义，t检验P<0.01）。与对照组（15名健康成年志愿者）相比，UC患者尿中Mg2+、草酸盐和柠檬酸盐的排泄量较低。临时回肠造口术后Ca2+排泄量显著增加而Mg2+排泄量下降。PTR术后Ca2+排泄量下降，Mg2+和柠檬酸盐排泄量增加。我们得出结论，接受PTR的患者尿量增加，且尿离子变化已知可降低患肾结石的风险。
