CAJ | 학술논문

根治性膀胱切除+尿流改道是肌层浸润性膀胱癌最有效治疗手段 ,但手术复杂、创伤大、手术时间长、围手术期并发症多和死亡率高.膀胱癌发病率随年龄增长而增加 ,随着我国老龄化进程的加速 ,高龄肌层浸润性膀胱癌患者也必将大幅度增加.尽管最近10多年来根治性膀胱切除术的技术有了很大提高 ,手术时间和术中出血明显减少 ,但围手术并发症和死亡并没有相应减少.高龄患者并存症较多 ,器官功能减退或代偿不完全 ,根治性膀胱切除尿流改道术围手术期并发症和死亡明显增加 ,因此对于高龄肌层浸润性膀胱癌患者施行根治膀胱切除需要慎重考虑.术前应仔细评价患者的总体状况、重要生命器官的功能状态和代偿情况、膀胱肿瘤浸润的程度和范围、以及对生活的影响和对生命的威胁程度 ,是否有其他切实可行的替代治疗方法等 ,仔细权衡、慎重选择 ,以争取最大获益.
근치성방광절제+뇨류개도시기층침윤성방광암최유효치료수단 ,단수술복잡、창상대、수술시간장、위수술기병발증다화사망솔고.방광암발병솔수년령증장이증가 ,수착아국노령화진정적가속 ,고령기층침윤성방광암환자야필장대폭도증가.진관최근10다년래근치성방광절제술적기술유료흔대제고 ,수술시간화술중출혈명현감소 ,단위수술병발증화사망병몰유상응감소.고령환자병존증교다 ,기관공능감퇴혹대상불완전 ,근치성방광절제뇨류개도술위수술기병발증화사망명현증가 ,인차대우고령기층침윤성방광암환자시행근치방광절제수요신중고필.술전응자세평개환자적총체상황、중요생명기관적공능상태화대상정황、방광종류침윤적정도화범위、이급대생활적영향화대생명적위협정도 ,시부유기타절실가행적체대치료방법등 ,자세권형、신중선택 ,이쟁취최대획익.
Radical cystectomy with urinary diversion is considered the gold standard surgical method for patients with mus-cle-invasive bladder carcinoma in regard to tumor control ,symptom palliation ,and survival .However ,it is associated with in-creased complexity and traumas ,long operation time ,and high rate of perioperative complications and mortality .As the inci-dence of disease increases with age and peaks in elderly patients .Although recent advances in surgical treatment have led to shorter operation time and less blood loss ,rate of perioperative co-morbidity and mortality are not decreased markedly for the elderly .Owing to high morbidity ,mortality and physiological changes ,the treatment for muscle-invasive bladder cancer pres-ents a conundrum .Therefore ,the selection of radical cystectomy for elderly patients should be considered carefully based on the patient's actual condition ,function and compensation of organs ,degree and size of lesion ,and alternative treatment to im-prove the benefit of invasive interventions .