重视女性膀胱癌诊疗技术的提升

The development of radical cystectomy technique in women

肿瘤存在性别差异已是共识.虽然女性膀胱癌的发病率仅为男性的30％,但其预后远不如男性患者.因此对其诊治应高度重视.根治性膀胱切除术是浸润性膀胱癌的标准治疗方式,但目前是否保留女性患者的生殖器官仍存在较大争议.综合文献报道,盆腔器官保留与否主要与膀胱肿瘤浸润程度有关,同时需考虑患者本人的意愿.关于女性患者尿流改道方式的选择,由于至今女性膀胱全切除例数报道较少,不同尿流改道方式的对比研究在方法、例数等方面均有瑕疵.因此,尿流改道方式的选择,需要根据各中心的技术特点并结合患者的具体情况和个人意愿进行.总之,早期诊断是提高女性膀胱癌预后的决定因素.传统女性膀胱全切除术对术后性功能有明显影响,保留盆腔器官的手术应作为有选择患者的优先考虑的术式.改善女性膀胱全切除术后患者的尿控和性功能尤为迫切、重要.

It has been well known that gender palys an important role in the development of tumors.Though bladder cancer mainly affects male population,female population shows a much worse prognosis,suggesting an urgent need for further studies in female UCB.Radical cystectomy （RC） remains the gold standard for muscle-invasive bladder cancer （MIBC）.Whether reproductive organs should be reserved for female MIBC patients remains controversial.It has been suggested that the tumor T stage plays an important role in the decision making regarding organs reservation.Meanwhile,the patents＆#39;will should also be taken into consideration.Given the relative small sample size of female MIBC patients reported in the literatures,it remains unclear which way presents the ideal way of urinary diversion for female population.The surgeons should consider the special condition of the center and patients＆#39;will regarding the decision making of urinary diversion.In conclusion,early diagnosis would improve the prognosis of UCB.Conventional RC may affect the sexual activity quality of female UCB patients,suggesting that moified RC with sexual organs reservation should be taken into consideration for selected patients.It is urgently needed to improve the urinary continence and the quality of sexual activity for female UCB patients who received RC.