Buson H, Diaz D C, Manivel J C, Jessurun J, Dayanc M, Gonzalez R
Department of Urologic Surgery, University of Minnesota Hospital and Clinics, Minneapolis.
J Urol. 1993 Aug;150(2 Pt 2):730-3. doi: 10.1016/s0022-5347(17)35599-4.
Bladder augmentation with segments of the gastrointestinal tract is commonly used to treat patients with small or noncompliant bladders. Reliable data on the incidence of tumors in patients with enterocystoplasty are not available. In the small number of cases reported in the literature the mean latency period is approximately 18 years. We designed a study in Sprague Dawley rats to try to determine the risk of carcinogenesis in different types of augmentation cystoplasty and its possible relationship with infected urine, and to investigate the possibility of detecting the tumors by cytological analysis. We performed 30 gastrocystoplasties, 35 sigmoid cystoplasties, 30 ileocystoplasties and 10 sham operations, and used 10 nonoperated animals as controls. The animals were sacrificed upon completing 1 year of followup and bladder urine samples were collected at the time of sacrifice. Of 115 animals 86 were available for histological evaluation (26 gastrocystoplasty, 22 sigmoid cystoplasty, 18 ileocystoplasty, and all sham and control animals). Mean followup was 11.2 months in the gastrocystoplasty, 11.8 months in the sigmoid cystoplasty, and 12 months in the ileocystoplasty, sham and control groups. Multifocal or superficial transitional metaplasia was found in 65.4% of the gastrocystoplasty, 50% of the sigmoid cystoplasty and 55.5% of the ileocystoplasty animals. Proliferations that we classified as papillary hyperplasia were present in 53.8% of the gastrocystoplasty, 40.9% of the sigmoid cystoplasty and none of the ileocystoplasty rats. The proliferations occurred either at or close to the anastomosis between the bladder and the gastric or colonic patch, or in areas of transitional metaplasia. Cytological urinalysis was negative for neoplastic cells in all cases. No correlation was found between the occurrence of papillary hyperplasia and urinary infection. These data indicate that in rats transitional metaplasia is common in gastrocystoplasty, sigmoid cystoplasty and ileocystoplasty, and that papillary hyperplasia may occur near or at the anastomosis, or in areas of transitional metaplasia in either gastrocytoplasty or sigmoid cystoplasty. In contrast to other studies, we observed no examples of papillary hyperplasia in the ileocystoplasty group in this series. No transitional cell carcinomas or adenocarcinomas were identified in this study. It is not known if these papillary lesions have an increased malignant potential, thus further studies with longer followup are warranted.
采用胃肠道节段进行膀胱扩大术常用于治疗膀胱过小或顺应性差的患者。关于肠膀胱扩大术患者肿瘤发生率的可靠数据尚无定论。文献报道的少数病例中，平均潜伏期约为18年。我们设计了一项针对斯普拉格-道利大鼠的研究，试图确定不同类型膀胱扩大成形术的致癌风险及其与感染尿液的可能关系，并研究通过细胞学分析检测肿瘤的可能性。我们进行了30例胃膀胱扩大成形术、35例乙状结肠膀胱扩大成形术、30例回肠膀胱扩大成形术和10例假手术，并将10只未手术的动物作为对照。随访1年后处死动物，并在处死时采集膀胱尿液样本。115只动物中，86只可进行组织学评估（26例胃膀胱扩大成形术、22例乙状结肠膀胱扩大成形术、18例回肠膀胱扩大成形术以及所有假手术和对照组动物）。胃膀胱扩大成形术组的平均随访时间为11.2个月，乙状结肠膀胱扩大成形术组为11.8个月，回肠膀胱扩大成形术组、假手术组和对照组为12个月。在65.4%的胃膀胱扩大成形术动物、50%的乙状结肠膀胱扩大成形术动物和55.5%的回肠膀胱扩大成形术动物中发现多灶性或浅表性移行化生。我们归类为乳头状增生的增殖病变出现在53.8%的胃膀胱扩大成形术动物、40.9%的乙状结肠膀胱扩大成形术动物中，而回肠膀胱扩大成形术大鼠中未出现。这些增殖病变发生在膀胱与胃或结肠补片的吻合处或附近，或移行化生区域。所有病例的尿液细胞学分析均未发现肿瘤细胞。乳头状增生的发生与泌尿系统感染之间未发现相关性。这些数据表明，在大鼠中，胃膀胱扩大成形术、乙状结肠膀胱扩大成形术和回肠膀胱扩大成形术中移行化生常见，乳头状增生可能发生在胃膀胱扩大成形术或乙状结肠膀胱扩大成形术的吻合处附近或吻合处，或移行化生区域。与其他研究不同，本系列回肠膀胱扩大成形术组未观察到乳头状增生的病例。本研究未发现移行细胞癌或腺癌。尚不清楚这些乳头状病变的恶性潜能是否增加，因此有必要进行更长时间随访的进一步研究。
