Huang George J, Stein John P
Department of Urology, University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, California 90098, USA.
Curr Opin Urol. 2007 Sep;17(5):369-75. doi: 10.1097/MOU.0b013e3282dc95b5.
Radical cystectomy with an appropriate lymph node dissection and an appropriate form of urinary diversion is the standard treatment for muscle-invasive transitional cell carcinoma of the bladder. Optimal outcomes following radical cystectomy require an extended lymph node dissection, negative surgical margins, and a continent urinary diversion. There has been an increasing number of reports describing initial experiences with laparoscopic radical cystectomy.
Intermediate and long-term oncologic outcomes with laparoscopic radical cystectomy remain undefined, and appropriate lymph node dissections laparoscopically have not been uniformly performed. Furthermore, the long-term functional outcomes associated with laparoscopically performed urinary diversions also remain undefined. There appears to be a recent trend toward performing the urinary diversion portion of the procedure extracorporeally, after laparoscopic removal of the bladder. Some studies suggest a decrease in postoperative analgesic requirements and quicker recovery of bowel function in those undergoing laparoscopic radical cystectomy, but these observations have not been corroborated by others.
In the absence of long-term functional and oncologic outcome data, laparoscopic radical cystectomy should be considered an investigative technique, and potential candidates for this operation should be appropriately counseled.
根治性膀胱切除术联合适当的淋巴结清扫及合适的尿流改道方式是膀胱肌层浸润性移行细胞癌的标准治疗方法。根治性膀胱切除术后的最佳疗效需要扩大淋巴结清扫、切缘阴性以及可控性尿流改道。越来越多的报告描述了腹腔镜根治性膀胱切除术的初步经验。
腹腔镜根治性膀胱切除术的中长期肿瘤学疗效尚不明确，腹腔镜下合适的淋巴结清扫也未得到统一实施。此外，腹腔镜下尿流改道的长期功能疗效也不明确。最近似乎有一种趋势，即在腹腔镜切除膀胱后，在体外进行手术的尿流改道部分。一些研究表明，接受腹腔镜根治性膀胱切除术的患者术后镇痛需求减少，肠功能恢复更快，但其他研究并未证实这些观察结果。
在缺乏长期功能和肿瘤学疗效数据的情况下，腹腔镜根治性膀胱切除术应被视为一种研究性技术，应对该手术的潜在候选者进行适当的咨询。
