牛亦农根治性膀胱切除术后尿流改道技术探讨.pdfVIP

根治性膀胱切除术后 尿流改道技术探讨 牛亦 农邢念增 首都医科大学附属 朝阳医院 背 景 膀胱癌是泌尿系统常见的恶性肿瘤之一，肿瘤发 病率第九位，男性肿瘤发病率第四位 首首 33 为为 ，，其其 11 次就诊患者次就诊患者 0%0% 肌层浸润性膀胱癌肌层浸润性膀胱癌 中中 /3/3 已有转移灶 根治性膀胱切除术加尿流改道是治疗肌层浸润性 膀胱癌的标准术式 尿流改道方式的演化 The first reported urinary diversion into a bowel was by Simon in 1852 From 1950s, three paths ：  Noncontinent ileal or colon conduit  ContinContinent cutaneous diversionent cutaneous diversion  Orthotopic neobladder • 1979 Camey and Le Duc pioneering work • 1993 Four onsencus Conference on Bladder Cancer • 2012 ICUD-EAU International Consultation on Bladder Cancer : Urinary diversion 开放、腹腔镜抑或机器人? Robotic Intracorporeal Orthotopic Neobladder during Radical Cystectomy in 132 Patients Mihir M. Desai, Inderbir S. Gill, Andre Luis de Castro Abreu, Abolfazl Hosseini, Tommy Nyberg, Christofer Adding, Oscar Laurin, Justin Collins, Gus Miranda, Alvin C. C. Goh, Monish Aron, Peter WiklundGoh, Monish Aron, Peter Wiklund The Journal of Urology Volume 192, Issue 6, Pages 1734-1740 (December 2014) DOI: 10.1016/j.juro.2014.06.087 Copyright © 2014 American Urological Association Education and Research, Inc. Terms and Conditions Why NOT orthotopic bladder? technical difficulty longer operative times highhigher er plication rateplication rate 怎么改道?原位还是通道? 外院手术 抗返流机制存在必要性? Studer等认为在外括约肌放松腹压排尿的正常 情况下，顺应性良好的低压膀胱不会发生返流 HautHautmanman等在一项回顾性研究中等在一项回顾性研究中 抗返流抗返流与与 否对上 形态与功能没有影响 Skinner EC, Studer Pouch versus T-Pouch Orthotopic Ileal Neoblad