原位新膀胱术后功能保留的探索与思考

Exploration and thinking on functional preservation after orthotopic neobladder construction

根治性膀胱切除术联合原位新膀胱术的功能保留观念逐渐受到关注。贮尿排尿功能的重建是原位新膀胱术功能保留的基础,临床探索主要集中在新膀胱重建方式和流程的优化上,尚缺乏对现有术式特征的归纳总结及高质量的功能学对比研究。对于严格选择的患者,在保证肿瘤控制的基础上,结合术后规范的性功能康复指导,保留性神经的患者术后大多能保留较好的性功能。神经血管束及周围附属结构的保护结合术后功能锻炼,对患者术后尿控的改善至关重要。根据患者的临床特点选择合适的尿流改道方式并进行相关功能的保留,可以帮助患者术后建立起正常的生活模式,提升自我形象和生活质量。

The concept of functional preservation after orthotopic neobladder construction has gradually attracted attention.Reconstruction of urine storage and voiding is the basic function preservation of orthotopic neobladder.Clinical exploration mainly focuses on the optimization of neobladder reconstruction methods and procedures,and there is still a lack of summary of existing surgical characteristics and high-quality functional comparative studies.For strictly selected patients,on the basis of tumor control and standardized postoperative rehabilitation guidance,most patients with preserved nerve can retain satisfied sexual function after surgery.The protection of neurovascular bundle and ancillary structures combined with postoperative exercise is crucial to the improvement of urinary continence.According to the characteristics of patients,choosing the appropriate urinary diversion methods and function preserving can help patients establish a normal life style after surgery and improve their self-image and quality of life.