Poulsen A L, Overgaard K, Steven K
Department of Urology, Herlev Hospital, University of Copenhagen, Denmark.
Br J Urol. 1997 Mar;79(3):339-47. doi: 10.1046/j.1464-410x.1997.00376.x.
To assess bone metabolism following bladder substitution with the ileal Kock reservoir.
PATIENTS, SUBJECTS AND METHODS: The investigation comprised two separate studies, one with baseline measurements before and after surgery, and the second after surgery only, of bone mass, made using single-photon absorptiometry and dual-energy X-ray absorptiometry, biochemical variables of bone turnover, plasma analyses and measurements of renal calcium and phosphate excretion. After inclusion, both groups of patients were observed longitudinally for 2 years. The post-surgery study included 25 patients who had undergone bladder substitution (median age 67 years, range 44-75), with a median post-operative follow-up of 1.0 year (range 0.3-3.7), and 16 control subjects (either healthy or with other minor urological complaints; median age 62 years, range 34-80), and the pre-surgery study comprised seven patients who had undergone bladder substitution (median age 57 years, range 42-68).
Total body, forearm and spinal bone mineral contents were similar in patients with an ileal bladder substitute measured 1 year after surgery and in control subjects. There were equivalent significant changes in both the patients and control subjects during the 2-year observation period, with a 2-3% decrease in total body and forearm bone mineral content. The values were similar in patients with and without a mild metabolic acidosis. Plasma calcium, phosphate, total alkaline phosphatase, intact parathyroid hormone, vitamin D and osteocalcin were normal in both patients and control subjects. Renal excretion of calcium and phosphate was also similar in patients and in control subjects.
Ileal urethral Kock bladder substitution does not lead to accelerated bone mineral loss in elderly men, despite a mild metabolic acidosis in half of the patients.
评估回肠代膀胱术（Kock 贮尿囊）后骨代谢情况。
患者、研究对象与方法：本研究包括两项独立研究，一项是手术前后进行骨量基线测量，另一项仅在术后进行骨量测量，测量方法包括单光子吸收法和双能 X 线吸收法、骨转换生化指标、血浆分析以及肾钙和磷排泄量测定。纳入患者后，两组患者均进行了为期 2 年的纵向观察。术后研究纳入了 25 例接受膀胱替代术的患者（中位年龄 67 岁，范围 44 - 75 岁），术后中位随访时间为 1.0 年（范围 0.3 - 3.7 年），以及 16 名对照者（健康或有其他轻度泌尿系统疾病；中位年龄 62 岁，范围 34 - 80 岁），术前研究包括 7 例接受膀胱替代术的患者（中位年龄 57 岁，范围 42 - 68 岁）。
术后 1 年测量，回肠膀胱替代术患者的全身、前臂和脊柱骨矿物质含量与对照者相似。在 2 年观察期内，患者和对照者均有同等程度的显著变化，全身和前臂骨矿物质含量下降了 2 - 3%。有无轻度代谢性酸中毒的患者其数值相似。患者和对照者的血浆钙、磷、总碱性磷酸酶、完整甲状旁腺激素、维生素 D 和骨钙素均正常。患者和对照者的肾钙和磷排泄也相似。
尽管半数患者存在轻度代谢性酸中毒，但回肠代尿道 Kock 膀胱术不会导致老年男性骨矿物质加速流失。
