Adeyoju A B, Thornhill J, Lynch T, Grainger R, McDermott T, Butler M R
Department of Urology, Meath Hospital, Dublin, Ireland.
Br J Urol. 1996 Jul;78(1):80-3. doi: 10.1046/j.1464-410x.1996.05615.x.
To determine the nature, incidence and severity of bladder complications after supravesical urinary diversion without cystectomy and to identify preventative risk factors.
A retrospective study of the last 25 years identified 35 patients who had supravesical urinary diversion without concomitant cystectomy (33 ileal loop diversions and two cutaneous ureterostomies). Urinary diversion was performed for a variety of lower urinary tract pathologies. Patients with urinary tract neoplasia were excluded. There were 15 males (mean age 41 years, range 13-72) and 20 females (mean age 49 years, range 15-81) with a mean follow-up of 5.2 years (range 1-25).
There were bladder complications in 10 patients (28%) including pyocystis (one mild and two severe), haemorrhage (two mild and one severe) and pain/spasm (four mild and three severe). Patients with interstitial cystitis, bladder outflow obstruction and/or a vesical fistula appeared to have a higher risk of complications. Four patients required cystectomy to treat severe symptoms while the remaining six achieved control of symptoms with no surgery. No patient developed carcinoma during the follow-up.
We recommend that cystectomy is considered at the time of supravesical urinary diversion, particularly in patients with interstitial cystitis, bladder outflow obstruction or a chronically infected bladder and especially in those with a vesical fistula.
确定不进行膀胱切除术的膀胱上尿路改道术后膀胱并发症的性质、发生率和严重程度，并识别预防风险因素。
一项对过去25年的回顾性研究确定了35例接受膀胱上尿路改道且未同时进行膀胱切除术的患者（33例回肠袢改道和2例皮肤输尿管造口术）。进行尿路改道是针对多种下尿路疾病。排除患有尿路肿瘤的患者。有15名男性（平均年龄41岁，范围13 - 72岁）和20名女性（平均年龄49岁，范围15 - 81岁），平均随访5.2年（范围1 - 25年）。
10例患者（28%）出现膀胱并发症，包括膀胱积脓（1例轻度和2例重度）、出血（2例轻度和1例重度）以及疼痛/痉挛（4例轻度和3例重度）。患有间质性膀胱炎、膀胱流出道梗阻和/或膀胱瘘的患者似乎并发症风险更高。4例患者需要进行膀胱切除术以治疗严重症状，其余6例未经手术症状得到控制。随访期间无患者发生癌变。
我们建议在进行膀胱上尿路改道时考虑膀胱切除术，特别是对于患有间质性膀胱炎、膀胱流出道梗阻或慢性感染膀胱的患者，尤其是那些患有膀胱瘘的患者。
