Stein R, Lotz J, Andreas J, Fisch M, Prellwitz W, Hohenfellner R, Thüroff J W
Department of Urology, University of Mainz, School of Medicine, Germany.
World J Urol. 1998;16(4):292-7. doi: 10.1007/s003450050069.
The use of intestinal segments in genitourinary reconstruction could influence vitamin metabolism and affect the skeletal bone and its mineral content in the long term. In 137 patients, serum levels of the vitamins A, B1, B2, B6, B12, D, and E and of folic acid, bile acid, and ammonia as well as levels of intracorpuscular vitamin B12 and folic acid were examined and a red blood cell count was performed. The patients were divided into three groups (< or = 2 years, > 2 to < or = 4 years, and > 4 years after surgery) as well as into children and adults. In addition, bone mineral density (dual-photon absorptiometry) was measured in 25 patients. Of these, 16 patients were approximately 16.8 years s/p rectal reservoir, 6 were approximately 20.5 years s/p colonic conduit, two were 6 and 8 years s/p ileocecal pouch, and one adolescent was 5 years s/p ileal bladder augmentation. In all patients the levels of vitamins A, B1, B2, B6, D, and E and of folic acid, bile acid, and ammonia as well as the red blood cell count were within normal ranges. In children (n = 51) there was no significant drop in vitamin B12 levels after the operation. In adults (n = 86), serum vitamin B12 levels dropped significantly from 402 +/- 182 ng/l during the first 2 years after the operation to 292 +/- 204 ng/l after the 4th year (normal range 240-1,100 ng/l). No significant increase in the intracorpuscular vitamin B12 level was observed during the same period. The bone mineral density was normal in all 25 patients with different types of urinary diversion. In addition to regular examination (sonography, creatinine levels, and base excess), vitamin B12 levels should be determined at 4 years after urinary diversion. It remains unclear whether substitution is necessary. However, substitution is easy to achieve and cheaper than the regular determination of vitamin B12. No decrease in bone mineral content was seen in the long-term follow-up with early correction of the base excess (below -2.5).
在泌尿生殖系统重建中使用肠段可能会影响维生素代谢，并长期影响骨骼及其矿物质含量。对137例患者检测了血清维生素A、B1、B2、B6、B12、D、E以及叶酸、胆汁酸和氨的水平，同时检测了红细胞内维生素B12和叶酸水平，并进行了红细胞计数。患者被分为三组（术后≤2年、＞2至≤4年、＞4年）以及儿童和成人两组。此外，对25例患者进行了骨矿物质密度测量（双能光子吸收法）。其中，16例患者在直肠贮袋术后约16.8年，6例在结肠导管术后约20.5年，2例在回盲部袋术后分别为6年和8年，1例青少年在回肠膀胱扩大术后5年。所有患者的维生素A、B1、B2、B6、D、E以及叶酸、胆汁酸和氨的水平以及红细胞计数均在正常范围内。儿童（n = 51）术后维生素B12水平无显著下降。成人（n = 86）血清维生素B12水平从术后第1个2年内的402±182 ng/l显著下降至第4年后的292±204 ng/l（正常范围240 - 1100 ng/l）。同期红细胞内维生素B12水平未见显著升高。25例不同类型尿流改道患者的骨矿物质密度均正常。除了定期检查（超声、肌酐水平和碱剩余）外，尿流改道4年后应测定维生素B12水平。是否需要补充尚不清楚。然而，补充操作简便且比定期测定维生素B12成本更低。在早期纠正碱剩余（低于 -2.5）的长期随访中，未见骨矿物质含量下降。
