膀胱癌之微創手術－回顧與未來展望

根據西元2007年台灣國民健康局統計資料可發現，膀胱尿路上皮癌是泌尿生殖道惡性腫瘤的第二名。針對尿路上皮膀胱腫瘤的各種治療方式已在世界文獻中多所報導，對於肌肉侵犯行的膀胱尿路上皮癌而言，根除性膀胱切除手術容是目前治療的標準方式。西元1992年，Parra等人首先報告了利用腹腔鏡手術方式治療一位化膿性膀胱炎的女性患者。在那之後，國內外陸續有文獻報告，針對利用腹腔鏡手術方式，來進行膀胱尿路上皮腫瘤切除手術，並進一步進行人工膀胱重建手術。在過去這5年間，更有越來越多的文獻針對機械手臂協助下腹腔鏡膀胱根除性切除手術及尿液分流手術的報告。雖然針對腹腔鏡手術與傳統剖腹手術方式治療膀胱尿路上皮腫瘤之短期手術效果，在手術可行性及相關併發症發生率是可相媲美的，但是針對尿流改道的類型和中長期腫瘤的治療結果，仍存在有相當的討論空間。由於腹腔鏡手術技術在近幾年的不斷進展，腹腔鏡膀胱根除性切除手術被認為是膀胱尿路上皮癌的治療選擇之一。然而，這種手術仍因其手術的複雜性及各種不同的尿液分流方式成為泌尿外科醫師需要克服的障礙。其中以較長的手術時間與較高的手術併發症發生率為目前推行此種手術的大挑戰。腹腔鏡膀胱根除性切除手術仍需要外科醫師建立更為標準化的手術步驟、成立可緊密配合的手術團隊，以及利用更新穎的手術器械，來縮短手術時間及相關的併發症發生率，以期提供膀胱尿路上皮癌病患有更好的治療選擇。

關鍵字

膀胱癌；微創手術；腹腔鏡手術

並列摘要

Bladder urothelial carcinoma is the second most common malignancy of the urogenital tract. Radical cystectomy remains the gold standard of treatment for muscle invasive bladder urothelial carcinoma. Parra, who reported the first laparoscopic cystectomy in a female purulent cystitis patient, was the first surgeon to perform laparoscopic surgery on the urinary bladder. Since then, laparoscopic radical cystectomy has gradually gained acceptance. For the treatment of bladder urothelial cancer, the short-term outcome and complication rates of laparoscopic surgery were comparable to those of conventional open surgery. However, in the absence of reports on long-term outcome analysis, whether or not laparoscopic surgery remains controversial. In recent years, laparoscopic techniques have continued to improve, and laparoscopic radical cystectomy has become a viable option for the treatment of bladder urothelial carcinoma in select medical centers. However, the variety and complexity of urinary diversion are obstacles that urologists need to overcome. Standardized surgical procedures and innovative surgical instruments are required for urologists to make laparoscopic radical cysytectomy a popular, low complication, and widely accepted procedure.

並列關鍵字

bladder cancer ； minimally invasive surgery ； laparoscopic surgery

國際替代計量

膀胱癌之微創手術－回顧與未來展望

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