摘要
對於一名因病必須切除整個膀胱的患者而言，如何設計一個具有生理性功能的“膀胱代用品”（bladder substitute），以達到理想的尿路分流目的，實在是整個手術是否成功的重要環節之一。傳統性的尿道分流方式有：經皮腎臟造瘻，輸尿管皮膚造口術，迴腸通路（ileal conduit）或輸尿管乙狀結腸吻合術（ureterosigmoidostomy）。上述幾種尿路分流術各有其時代性和優劣點。尤其是迴腸通路從本世紀中葉發明迄金，仍為許多泌尿科醫師所鐘愛。但是自從1982年瑞典的寇克教授發明了“寇克氏囊”禁制性膀胱代用品之後（1），這個劃時代的創舉改變了尿路分流的原本風貌。從此，膀胱切除的病人不再忍受“失禁性尿路分流術”的困擾了。本文將對整個尿路分流手術之歷史沿革、特性和優劣性點作一全面性的整理，並提出慈濟醫院泌尿科在這方面之經驗引為參考。
並列摘要
An ideal as well as functional bladder substitute to divert the urine after total cystectomy is an important part of a successful operation in patients having bladder cancer. Traditionally, methods of urinary diversion include percutaneous nephrostomy, ureterocutaneostomy, ileal conduit and uretero-sigmoidostomy. However, these methods although timehonoured, they certainly possess some disadvantages. The invention of continent ileal urinary diversion by Kock in 1982 has largely changed the original style of urinary diversion. The inconvinence enfaced by the patients who have to wear an urinary collecting bag on their body surface when having an ileal conduit for urinary diversion become bothering no more. A continent & low pressure urinary reservoir with reflux preventing valve to protect upper urinary tract is theorativally superior to those old fashioned urinary diversions. We hereby present our experience of 10 cases having Kock pouch and 2 cases of appliance-free neobladder together with discussing of their clinical implications.