Izquierdo L, Bolton D M, Lawrentschuk N
Department of Surgery, University of Melbourne Melbourne, Australia -
Minerva Urol Nefrol. 2013 Dec;65(4):225-34.
Bladder cancer is the second most common urological malignancy, with urothelial carcinoma (transitional cell carcinoma) comprising almost 90% of all primary bladder tumours. Over recent decades, radical cystectomy has emerged as the predominant treatment modality for patients with high-grade, invasive urothelial cancers and for those with less-invasive disease who fail treatment with bladder-preservation strategies. Bladder substitution following radical cystectomy has become increasingly common and in many centers has evolved to become the standard method of urinary diversion. The main goal of this paper is to review intraoperative considerations for patients undergoing radical cystectomy with a focus on issues specific to surgical tricks with neobladder construction and postoperative complications.
Systematic literature review in Pubmed and Embase including bladder cancer, urinary diversion, neobladder, surgical technique and complications as key words.
Intraoperative techniques and modifications have made neobladder construction more amenable and the standard in suitable patients. Postoperative complications still occur in a significant number of patients but may be minimised and recognised early for better outcomes.
Orthotopic bladder substitution does not compromise oncological outcome and importantly can be performed with relatively good results regarding functional and quality of life issues. Modifications to intraoperative technique can assist with neobladder construction to aid better outcomes. Where possible orthotopic bladder substitution should be the diversion of choice. Of paramount importance is the active postoperative management and regular long-term follow-up of patients with an orthotopic bladder substitution.
膀胱癌是第二常见的泌尿系统恶性肿瘤，尿路上皮癌（移行细胞癌）占所有原发性膀胱肿瘤的近90%。在最近几十年中，根治性膀胱切除术已成为高级别浸润性尿路上皮癌患者以及那些采用膀胱保留策略治疗失败的低浸润性疾病患者的主要治疗方式。根治性膀胱切除术后的膀胱替代术越来越普遍，在许多中心已演变为尿流改道的标准方法。本文的主要目的是回顾根治性膀胱切除术患者的术中注意事项，重点关注新膀胱构建的手术技巧和术后并发症等特定问题。
在Pubmed和Embase上进行系统的文献综述，关键词包括膀胱癌、尿流改道、新膀胱、手术技术和并发症。
术中技术和改进使新膀胱构建对合适的患者更可行且成为标准术式。仍有相当数量的患者发生术后并发症，但可以将其降至最低并早期识别以获得更好的结果。
原位膀胱替代术不会影响肿瘤学结果，重要的是在功能和生活质量方面可以取得相对较好的效果。术中技术的改进有助于新膀胱构建以获得更好的结果。在可能的情况下，原位膀胱替代术应作为尿流改道的首选。至关重要的是对原位膀胱替代术患者进行积极的术后管理和定期的长期随访。
