Kalloo N B, Jeffs R D, Gearhart J P
James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
Urology. 1997 Dec;50(6):967-71. doi: 10.1016/S0090-4295(97)00470-6.
To identify whether nutritional abnormalities, specifically vitamin B12 deficiency, folate deficiency, and low carotene levels, are long-term sequelae of the use of ileum and/or colon for lower urinary tract reconstruction in pediatric patients.
Serum levels of vitamin B12, methyl malonic acid (MMA), carotene, and folate were measured 3 to 13 years (mean 6) after surgery in patients less than 18 years old at the time of operation.
Thirteen (44.8%) of 29 patients had abnormal nutritional serum levels, with 5 (38.5%) of 13 having more than one abnormal value. Vitamin B12 was low in 4 (14%) of 29 patients; MMA was abnormally high in 7 (26%) of 27; and both folate and carotene levels were low in 4 (14.8%) of 27. No patient with reconstruction with colon alone (n = 3) had abnormal values, and no patient had any clinical signs or symptoms of vitamin B12 deficiency or fat malabsorption.
Nutritional abnormalities can occur in patients after lower urinary tract reconstruction with ileum. No patient in this study had symptomatic abnormalities; however, long-term clinical effects may be significant. The implications of low folate levels in women of childbearing age must also be taken into consideration because of the potential association with congenital anomalies.
确定营养异常，特别是维生素B12缺乏、叶酸缺乏和低胡萝卜素水平，是否是小儿患者使用回肠和/或结肠进行下尿路重建的长期后遗症。
对手术时年龄小于18岁的患者，在术后3至13年（平均6年）测量血清维生素B12、甲基丙二酸（MMA）、胡萝卜素和叶酸水平。
29例患者中有13例（44.8%）血清营养水平异常，13例中有5例（38.5%）有不止一项异常值。29例患者中有4例（14%）维生素B12水平低；27例中有7例（26%）MMA异常高；27例中有4例（14.8%）叶酸和胡萝卜素水平均低。仅行结肠重建的患者（n = 3）无异常值，且无患者有维生素B12缺乏或脂肪吸收不良的任何临床体征或症状。
小儿回肠代膀胱术后可能出现营养异常。本研究中无患者有症状性异常；然而，长期临床影响可能很大。由于与先天性异常的潜在关联，育龄妇女叶酸水平低的影响也必须予以考虑。
