膀胱癌根治术联合原位新膀胱的研究现状及展望

Research Status and Prospect of Radical Cys-tectomy Combined with Orthotopic Ne-obladder

摘要: 根治性膀胱切除术是目前治疗肌层浸润性膀胱癌的金标准，但术后尿流改道尚无统一标准。在众多的尿流改道方式中，膀胱原位术因其符合患者的生理排泄功能，且可以大大提高患者的生活质量，近年来成为一研究热点，在其手术方式的选择，膀胱重建的方式等方面在不断发展和创新。当下机器人辅助腹腔镜根治性膀胱切除术(RARC)联合回肠膀胱置换术(VescicaIleale Padovana, VIP)近年来越来越兴起，在围手术期并发症发生率和术后恢复时间等方面优于开放手术。在膀胱的构建方面本文列举了五种术式，分别为机器人辅助的体内金字塔式新膀胱术、机器人体内Padua回肠膀胱(PIB)手术技术、Karolinska- modified Studer新膀胱、Abole-Enein和Ghomeim的W型新膀胱、机器人体内Hautmann新膀胱。各有其优点，有着广阔的发展前景。另外该手术存在一些并发症，在临床过程中应根据病人自身情况和不同医疗水平选择最合适的手术方法，尽量减少相关并发症的发生，同时对于术后的新膀胱功能，也给了一些相关的锻炼方法。本文就膀胱根治术联合原位膀胱的研究现状和展望做一综述。

Abstract: Radical cystectomy is the gold standard for muscular invasive bladder cancer, but the postoperative urinary diersion, there is no unified standard. In so many ways of urinary diersion, bladder in situ technique because of its accord with excretion function in patients with, and can significantly im-prove the patient’s quality of life, become a hot research topic in recent years, in the choice of the ways of its operation, the manners of bladder reconstruction in continuous development and inno-vation. Robot-assisted laparoscopic radical cystectomy (RARC) combined with VescicaIleale Pado-vana (VIP) is more and more popular in recent years, which is superior to open surgery in terms of perioperative complications and postoperative hospital stay. In the aspect of the construction of the bladder, this article lists the five kinds of operation. They were robot-assisted intracorporeal pyra-mid neobladder, intracorporeal Padua ileal neobladder (PIB) surgical technique, Karolin-ska-modified Studer neobladder, Abole-Enein and Ghomeim W neobladder, and intracorporeal Hautmann neobladder. Each has its advantages and has broad prospects for development. In addi-tion, there are some complications of the operation. In the clinical process, the most appropriate surgical method should be selected according to the patient’s own condition and different medical level to minimize the occurrence of related complications. At the same time, some related exercise methods are also given for the function of the new bladder after the operation. This article reviews the research status and prospect of radical cystectomy combined with orthotopic bladder.