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Acid-base disorders after orthotopic bladder replacement: comparison of an ileal neobladder and an ileal conduit

机译:原位膀胱置换术后的酸碱性疾病:回肠新膀胱和回肠导管的比较

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Abstract Objectives: For many years, creation of an orthotopic neobladder after cystectomy has been popular. In the present study, we measured the extent of metabolic acidosis in patients with ileal neobladders compared with ileal conduits and defined risk factors for development of metabolic acidosis. Methods: We retrospectively studied 95 patients, who underwent radical cystectomy and urinary diversion to treat invasive bladder cancer from January 2001 to December 2014 at Hallym University Kangnam Sacred Heart Hospital, through investigation of acid-base balance, serum electrolyte levels and renal function one month and one year after operation. Results: One month after the operation, metabolic acidosis was found from 18 patients (31.0%) in an ileal neobladder group and from 4 (14.8%) in an ileal conduits group. One year after the operation, the numbers became 11 (22.9%) and 2 (10.0%), respectively. However, there was not a statistical difference. The blood biochemical profiles of the two groups did not differ significantly after urinary diversion. Logistic analysis revealed that lower estimated glomerular filtration rate (eGFR) was associated with metabolic acidosis at one month (odds ratio, OR?=?0.94 [0.91–0.97]; p?P?=?0.001) after urinary diversion. In multivariate analysis, lower eGFR is a significant risk factor for metabolic acidosis at one month. Conclusions: Patients with ileal neobladders and conduits are at the similar risk of metabolic acidosis. A close association between renal function and development of metabolic acidosis was observed, especially stronger in an early period after operation.
机译:摘要目的:多年来,膀胱切除术后原位新膀胱的形成已广为流行。在本研究中,我们测量了与回肠导管相比回肠新膀胱患者的代谢性酸中毒程度,并确定了发生代谢性酸中毒的危险因素。方法:我们回顾性研究了2001年1月至2014年12月在哈里姆大学康南圣心医院接受根治性膀胱切除术和尿流改道治疗浸润性膀胱癌的95例患者,通过调查其酸碱平衡,血清电解质水平和肾功能一个月一年后结果:术后1个月,回肠新膀胱组18例(31.0%)和回肠导管组4例(14.8%)发现代谢性酸中毒。手术一年后,该数字分别变为11(22.9%)和2(10.0%)。但是,没有统计学差异。尿流改道后,两组的血液生化特征无明显差异。 Logistic分析显示,尿液改道后一个月,估计的肾小球滤过率(eGFR)降低与代谢性酸中毒有关(比值比,OR?=?0.94 [0.91-0.97]; p?P?=?0.001)。在多变量分析中,较低的eGFR是一个月后发生代谢性酸中毒的重要危险因素。结论:回肠新膀胱和导管患者处于代谢性酸中毒的相似风险中。观察到肾功能与代谢性酸中毒的发展密切相关,尤其是在术后早期。

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