Tschopp A B, Lippuner K, Jaeger P, Merz V W, Danuser H, Studer U E
Department of Urology, University of Berne, Switzerland.
J Urol. 1996 Jan;155(1):71-5. doi: 10.1097/00005392-199601000-00022.
The use of bowel segments as bladder substitutes may result in chronic, impaired vitamin D and calcium metabolism, and ultimately in bone demineralization.
Bone metabolism was examined in 14 patients who lived for 5 to 8 years with an ileal low pressure bladder substitute after radical cystectomy for bladder cancer. Bone mineral density was measured using dual energy x-ray absorptiometry of the total skeleton, lumbar spine, femoral neck, and tibial epiphysis and diaphysis. Laboratory studies included serum levels of 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, intact parathyroid hormone, plasma alkaline phosphatase, electrolytes, creatinine and blood gas analysis.
Bone mineral density was normal in all patients. There was no evidence of deficient vitamin D stores. There was a tendency toward slightly elevated serum creatinine values in patients with preexisting impaired renal function, including 1 who also had slight acidosis. No patient had hyperchloremia.
We found no evidence of osteomalacia, osteoporosis or significant metabolic acidosis in 14 patients with an ileal bladder substitute for 5 to 8 years. However, it is not known whether the absence of osteopenia would also apply to patients with poor renal function, to those not followed meticulously and, thus, at risk for major long-term functional or metabolic disturbances from the ileal bladder substitute or to patients with orthotopic bladder substitutes made from longer or other bowel segments than we used.
使用肠段作为膀胱替代物可能导致慢性维生素D和钙代谢受损，并最终导致骨质脱矿。
对14例因膀胱癌行根治性膀胱切除术后使用回肠低压膀胱替代物存活5至8年的患者进行骨代谢检查。使用双能X线吸收法测量全身骨骼、腰椎、股骨颈以及胫骨骨骺和骨干的骨密度。实验室检查包括血清1,25-二羟维生素D、25-羟维生素D、完整甲状旁腺激素、血浆碱性磷酸酶、电解质、肌酐水平以及血气分析。
所有患者的骨密度均正常。没有维生素D储备不足的证据。肾功能预先受损的患者血清肌酐值有轻微升高的趋势，其中1例还伴有轻度酸中毒。没有患者出现高氯血症。
我们发现14例使用回肠膀胱替代物5至8年的患者没有骨软化症、骨质疏松症或明显代谢性酸中毒的证据。然而，骨量减少的情况不存在是否也适用于肾功能不佳的患者、未得到精心随访因而有因回肠膀胱替代物出现重大长期功能或代谢紊乱风险的患者，或者适用于使用比我们所使用的更长或其他肠段制成的原位膀胱替代物的患者，目前尚不清楚。
