Bogaert G A, Mevorach R A, Kim J, Kogan B A
Department of Urology, University of California School of Medicine, San Francisco, USA.
J Urol. 1995 Jun;153(6):1977-80.
To determine the physiology of acid secretion after gastrocystoplasty with the body of the stomach we performed a prospective standardized 3-day study in 13 children (median age 12.5 years) who had undergone bladder augmentation/replacement (median postoperative period 2 years). Urinary pH and titratable acid, and serum gastrin levels were measured after gastric distention with a meal and bladder distention with urethral filling at baseline and after medication with a histamine-2 receptor antagonist or an anticholinergic agent. Five children underwent cystoscopy and biopsy of the gastric and native segments of the gastrocystoplasty. In the fasting state pH was neutral, there was no titratable acid in the urine and serum gastrin level was normal in all cases. After a meal urinary acid secretion and serum gastrin level increased markedly. After each medication half of the patients demonstrated marked inhibition of urinary acid secretion after a meal while response was partial in the remainder. In none of the patients was there significant alteration in the pattern of gastrin secretion. Bladder distention did not result in urinary acid secretion or gastrin secretion. The cystoscopic and histological appearance of the native bladder and stomach segment of the gastrocystoplasty in the 5 patients was normal. We conclude that the gastric body segment used in gastrocystoplasty continues to secrete acid as though it were part of the stomach. The secretion of acid in the urine can be decreased with histamine-2 receptor antagonist or anticholinergic medication.
为了确定使用胃体进行胃膀胱扩大术后的胃酸分泌生理情况，我们对13名儿童（中位年龄12.5岁）进行了一项前瞻性标准化的3天研究，这些儿童均接受了膀胱扩大/置换手术（中位术后时间2年）。在基线状态以及使用组胺-2受体拮抗剂或抗胆碱能药物治疗后，在通过进食使胃扩张以及通过尿道充盈使膀胱扩张后，测量尿pH值、可滴定酸以及血清胃泌素水平。5名儿童接受了膀胱镜检查以及胃膀胱扩大术的胃段和原膀胱段活检。在禁食状态下，pH值呈中性，所有病例尿液中均无可滴定酸，血清胃泌素水平正常。进食后，尿酸分泌和血清胃泌素水平显著升高。每次用药后，一半患者进食后尿酸分泌受到明显抑制，而其余患者反应为部分抑制。在所有患者中，胃泌素分泌模式均无显著改变。膀胱扩张未导致尿酸分泌或胃泌素分泌。5名患者的胃膀胱扩大术中原膀胱段和胃段的膀胱镜及组织学表现正常。我们得出结论，胃膀胱扩大术中使用的胃体段继续分泌胃酸，就好像它是胃的一部分。组胺-2受体拮抗剂或抗胆碱能药物可减少尿中酸的分泌。
