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背景:许多报道指出,尿流改道后会出现代谢紊乱和病理生理的变化,但是这些用肠道重建膀胱替代手术引起的代谢紊乱主要与肠管类型及长度相关。目的:观察Roux-y乙状结肠新膀胱替代后贮尿囊黏膜的变化及对代谢的影响。设计、时间及地点:回顾性病例分析,于2000-06/2008-11在解放军第一八四医院泌尿外科完成。对象:33例膀胱癌患者,男21例,女12例,平均年龄64岁。对照组为25例经胃肠镜活检无乙状结肠疾病史者。方法:采用根治性膀胱全切、利用肛门括约肌控尿的Roux-y乙状结肠新膀胱术进行手术治疗膀胱癌患者,分析新膀胱引流管拔管前后血电解质、肌酐和尿素的变化,并对其中13例患者的贮尿囊黏膜于术前、术后36个月取材作病理学检查。对照组为25例无乙状结肠疾病史者乙状结肠黏膜。检测项目包括肠黏膜厚度及腺体数目。主要观察指标:手术前、拔管前后电解质、肾功能和酸碱平衡、黏膜层厚度、腺体数目。结果:30例患者术后血电解质、肌酐和尿素均保持在正常范围,拔管前后电解质、肌酐和尿素的变化差异无显著性意义,3例患者表现有轻度的酸中毒。对照组手术前后结肠黏膜镜下改变不明显,基本保持了正常的组织结构。手术组术后黏膜层厚度变薄[(577.6±169.4),(412.5±114.7)μm,P<0.05],肠腺排列疏松,间质稀少,单位腺体数目减少[(26.4±3.5),(15.2±2.7)个/HP,P<0.05]。术后新膀胱内的肠绒毛逐渐萎缩,肠上皮细胞未见增生及恶性改变。结论:Roux-y乙状结肠新膀胱替代后肠黏膜层厚度变薄,肠腺排列疏松,间质稀少,单位腺体数目减少,人体代谢无明显变化。
BACKGROUND: Many reports indicate that metabolic disturbances and pathophysiological changes occur after urinary diversion. However, these metabolic disorders associated with bladder replacement surgeries are mainly related to the type and length of the intestine. Objective: To observe the change of urinary bladder mucosa after Roux-y sigmoid colon replacement and its effect on metabolism. DESIGN, TIME AND SETTING: The retrospective case analysis was performed at the Urology Department of the 184th People’s Liberation Army in 2000-06 / 2008-11. Subjects: 33 cases of bladder cancer patients, 21 males and 12 females, average age 64 years old. The control group was 25 cases of gastrointestinal biopsy without history of sigmoid colon disease. Methods: The patients with bladder cancer were treated with radical cystectomy and Roux-y sigmoid colon nephroureterectomy with anal sphincter control. The changes of blood electrolytes, creatinine and urea before and after extubation of the new bladder were analyzed. Cases of patients with storage of urine in the mucosa preoperative and postoperative 36 months taken for pathological examination. The control group was 25 cases of sigmoid colon mucosa with no history of sigmoid colon disease. Test items include intestinal mucosal thickness and the number of glands. MAIN OUTCOME MEASURES: Electrolytes before and after extubation, renal function and acid-base balance, mucosal layer thickness, number of glands. Results: Electrolytes, creatinine and urea remained unchanged in 30 patients after operation. There were no significant differences in electrolyte, creatinine and urea before and after extubation. Three patients showed mild acidosis. The control group before and after colonoscopic mucosal changes were not obvious, the basic structure to maintain the normal. The thickness of the mucosa in the operation group was thinner ([(577.6 ± 169.4) vs (412.5 ± 114.7) μm, P <0.05]. The intestinal glands were loosely arranged and sparsely interstitial with the number of glands reduced [(26.4 ± 3.5) 15.2 ± 2.7) /HP, P <0.05]. The intestinal villus in the new bladder gradually atrophied, but no proliferation and malignant changes in intestinal epithelial cells. Conclusions: Roux-y cholecystectomy results in thinning of the intestinal mucosa of intestine, loosely arranged intestinal glands, sparse interstitial tissues, reduced number of glands per unit area, and no significant changes in human metabolism.