臨床泌尿器科63巻4号

2009年04月発行

特集 イラストレイテッド 膀胱全摘除術と尿路変向術

膀胱全摘除術の適応と選択

2．膀胱全摘除術の適応と選択

著者： 山中望¹ 日向信之¹ 山崎隆文¹ 大場健史¹ 結縁敬治¹

所属機関： ¹神鋼病院泌尿器科

ページ範囲：P.23 - P.29

文献概要

要旨：膀胱全摘除術と骨盤リンパ節郭清術は，浸潤性膀胱癌に対する標準治療である。しかし，手術侵襲が高いことや尿路変向術によるQOL低下などから，たとえ浸潤癌であっても，患者も医師もその受け入れを躊躇せざるを得ない場合があった。1980年代に登場したneobladderは，術後のライフスタイルにほとんど変化がないことから急速に普及し，T1G3から局所浸潤癌まで適応が拡大されつつある。本稿では，①neobladderを選択する場合の腫瘍学的考察，②T1G3の概念と膀胱全摘除術の適応，③骨盤リンパ節郭清の意義，④尿路変向術の選択，などにつき筆者らの経験を概説するとともに，若干の文献的考察を加えた。

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