膀胱癌术后尿流改道与膀胱替代的现状与进展  

Progress in urinary diversion and bladder substitution after operation of bladder cancer

作　　者：王文佳[1,2] 李胜文[1,2] 

机构地区：[1]清华大学医学中心,北京100084 [2]清华大学第一附属医院泌尿外科

出　　处：《中华临床医师杂志（电子版）》2015年第2期4-7,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：根治性全膀胱切除是治疗肌层浸润性膀胱癌的金标准,但膀胱全切术后尿流改道方式的选择尚无统一标准。尿流改道术主要包括不可控尿流改道术、可控性尿流改道术、原位新膀胱术三种方式。在条件允许的情况下,应将原位新膀胱作为膀胱替代的首选方式。而乙状结肠原位膀胱更接近自然膀胱的功能,是一种理想的尿流改道方式。对于肿瘤侵犯尿道或尿道狭窄不能经尿道排尿的患者,乙状结肠直肠膀胱术是越来越被广泛接受的可控性尿流改道方式。Bricker回肠膀胱术因手术简单、并发症少,仍被广泛应用。而输尿管皮肤造口术则特别适用于年龄大、体质差、耐受力低、不能承受复杂手术的患者。组织工程技术为膀胱替代带来了新的希望,组织工程膀胱的一系列基础研究显示了广阔临床应用前景。Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer. But there are no uniform criteria for the urinary reconstructive options after radical cystectomy. The types of urinary diversion fall into three major categories： noncontinent cutaneous diversion, continent coetaneous diversion and continent orthotopic diversion. Among appropriately selected patients, the orthotopic neobladder should be a top priority. Sigmoid neobladder as an ideal form of orthotopic urinary reconstruction comes closest to the natural bladder’s urine storage and voiding function. When involvement of the urethra by tumour prevents the choice of an orthotopic neobladder, sigma rectum pouch will be accepted by more and more people as a continent cutaneous diversion. Bricker ileal neobladder is still widely used for simple operations, fewer complications, for elderly patients and those with a poor performance status, the ureterocutaneostomy is a reliable option. Tissue engineering approaches provide new possibilities by creating a man-made construct to replace the bladder. A series of basic researches of tissue engineering of the bladder show a wide prospect of clinical application in the future.

关 键 词：膀胱肿瘤 尿流改道术 膀胱替代 

分 类 号：R737.14[医药卫生—肿瘤]