Effects of restorative proctocolectomy on renal and adrenal function
Effects of restorative proctocolectomy on renal and adrenal function
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恢复性直肠结肠切除术对肾和肾上腺功能的影响
DOI：
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发表时间：
1999
影响因子：
3.9
通讯作者：
C. Herfarth
中科院分区：
文献类型：
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作者：
F. Huber;Josef Stern;Ulf Hinz;E. Werle;D. Haack;Peter Kienle;U. Heuschen;M. Aulmann;C. Decker;C. Herfarth
目的：修复性直肠结肠切除术是溃疡性结肠炎和家族性腺瘤性息肉病外科治疗的标准方法。根治性切除结直肠并建立回肠造口常导致造口丢失率高。这些可能导致电解质和酸碱平衡的变化以及肾和肾上腺功能的改变。方法：在这项研究中，33例患者接受回肛袋直肠结肠切除术前后进行了调查，在不同的时间间隔电解质的变化，改变酸碱平衡，肾功能，肾上腺激素的变化。在直肠结肠切除术前、直肠结肠切除术后10天、回肠造口闭合前和回肠造口闭合后6 - 12个月进行测量。未观察到急性肾衰竭或其他重要并发症。研究结果：统计分析显示尿液pH值显著降低至5.4±0.22（回肠造口闭合前）和代谢性酸中毒（pH值7.32±0.04;碱过剩-1.3 ±5.6（回肠造口闭合前））。同样，我们发现肾清除率降低至86 ml/min（回肠造口闭合前），无肾小管损伤迹象。回肠造口期间最重要的变化是功能性继发性醛固酮增多症，醛固酮水平为63.2±70.8 ng/dl（回肠造口闭合前）。与术前水平相比，盐皮质激素肾上腺活性增加了10倍。此外，在保护性回肠造口术期间，肝脏合成的醛固酮-18-葡萄糖醛酸苷仅略有增加，皮质醇/可的松比值极低。结论：这些结果表明，恢复性直肠结肠切除术与回肠袋肛门吻合和保护性袢回肠造口术显着影响液体，电解质和酸碱平衡。功能性继发性醛固酮增多症对随后的肾脏再代偿至关重要。回肠造口闭合后约半年，具有盐皮质激素效应的内源性激素恢复至正常水平。
PURPOSE: Restorative proctocolectomy is a standard procedure in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. The radical removal of the colorectum with construction of an ileostomy often results in high stoma losses. These may lead to changes in the electrolyte and acid-base balance and to alterations in renal and suprarenal gland function. METHODS: In this study 33 patients who received an ileoanal pouch before and after proctocolectomy were investigated at different time intervals for electrolyte changes, alteration of the acid-base balance, kidney function, and hormonal changes of the suprarenal glands. Measurements were performed before proctocolectomy, ten days after proctocolectomy with ileal pouch-anal anastomosis under protective loop ileostomy, before ileostomy closure, and 6 to 12 months after ileostomy closure. Neither acute renal failure nor other vital complications were observed. RESULTS: Statistical analysis showed a significant decrease of urine pH to 5.4±0.22 (before ileostomy closure) and metabolic acidosis (pH 7.32±0.04; base excess −1.3±5.6 (before ileostomy closure)). Likewise, we found a decrease in renal clearance to 86 ml/minute (before ileostomy closure) without signs of tubular damage. The most important change during the phase with ileostomy was a functional secondary hyperaldosteronism with aldosterone levels of 63.2±70.8 ng/dl (before ileostomy closure). In comparison with preoperative levels, there was a ten-fold increase in mineralocorticoid adrenal activity. Additionally, during the period with protective ileostomy, the hepatic synthesis of aldosterone-18-glucuronide was only slightly increased, and the cortisol/cortisone ratio was extremely decreased. CONCLUSIONS: These results show that restorative proctocolectomy with ileal pouch-anal anastomosis and protective loop ileostomy significantly influences fluid, electrolyte, and acid-base balance. Functional secondary hyperaldosteronism is of central importance for subsequent renal recompensation. Approximately one-half year after ileostomy closure, the endogenous hormones with mineralocorticoid effects returned to normal levels.
糖皮质激素对正常人和溃疡性结肠炎患者直肠运输的影响。
影响因子：
24.5
作者：
Sandle,GI;Hayslett,JP;Binder,HJ
通讯作者：
Binder,HJ