高龄膀胱癌患者行根治性膀胱切除术再认识

Rethinking the role of radical cystectomy in treating bladder cancer in elderly patients

摘要:

随着我国人口老龄化进展，膀胱癌患者大幅度增加。根治性膀胱切除术+尿流改道是治疗肌层浸润性膀胱癌最有效的手段，但其手术步骤复杂、手术时间长、围手术期并发症多、死亡率高。高龄患者合并症较多，器官功能减退或代偿不全，能否耐受根治性膀胱切除术尤其值得关注。近年来，通过术前仔细评估高龄患者的总体状况，采用腹腔镜或机器人辅助腹腔镜等微创技术，提高根治性膀胱切除术技巧，优化手术步骤，将复杂手术程序化、简单化，提升围手术期护理质量，能有效降低围手术期患者并发症发生率和死亡率，使高龄患者有更大的生存获益。

Abstract:

The population aging in China has led to a substantial increase in the number of bladder cancer patients. At present, radical cystectomy together with urinary diversion is the most effective treatment for muscle invasive bladder cancer, but it has the disadvantages of complicated operative procedures, long operative duration, high incidence of perioperative complications and high mortality. In addition, due to multiple comorbidities and compromised organ function, whether elderly patients can tolerate the radical cystectomy is particularly worthy of attention. In recent years, the incidence of perioperative complications and the mortality have been decreased by carefully evaluating the overall condition of elderly patients before the surgery, adopting minimally invasive techniques such as video-assisted or robot-assisted laparoscopy, enhancing surgical skills, optimizing surgical procedures, simplifying the complicated surgery, and improving the quality of perioperative care, thus resulting in greater benefits for the elderly patients.