原位回肠新膀胱术后多发新膀胱结石一例并文献回顾

Multiple New Reservoir Stones after Orthotopic Ileal Neobladder: A Case Report and Literature Review

摘要: 目的：探讨原位回肠新膀胱术后无症状性结石的形成机制及临床管理策略。方法：报道1例女性患者行根治性膀胱切除术 + 原位回肠新膀胱术后3年，经影像学检查发现新膀胱内多发结石。尿培养提示肺炎克雷伯菌感染。行经尿道钬激光碎石术，术中见结石紧密附着于暴露的肠道吻合钉表面。结果：术后恢复良好，6个月随访无复发。结合文献报道，回肠新膀胱术后3年及5年结石发生率分别达8%和19.5%，主要与吻合钉裸露相关。结论：吻合钉暴露是结石形成的重要危险因素。建议术中减少钛合金吻合钉的使用，避免吻合钉的位移暴露，同时加强术后长期随访与感染控制，以降低结石发生风险。

Abstract: Objective: To investigate the mechanisms of formation and clinical management strategies for asymptomatic stones in orthotopic ileal neobladder. Methods: We report a female patient who underwent radical cystectomy with orthotopic ileal neobladder reconstruction. Three years postoperatively, imaging revealed multiple stones within the neobladder. Urine culture grew Klebsiella pneumoniae. The patient underwent transurethral holmium laser lithotripsy; intraoperatively, stones were found to be tightly adherent to exposed intestinal anastomotic staples. Results: The postoperative course was uneventful, and no recurrence was observed at 6-month follow-up. Combined with literature reports, the incidence of stones after ileal neobladder formation is 8% at 3 years and 19.5% at 5 years, mainly associated with exposed staples. Conclusion: Exposure of anastomotic staples is an important risk factor for neobladder stone formation. It is recommended to minimize the use of titanium alloy anastomotic staples during surgery to avoid exposure due to staple displacement, while enhancing long-term postoperative follow-up and infection control to reduce the risk of stone formation.