得了膀胱癌,坚决不全切?新手术方案让他恢复自主排尿及性功能

2021-01-20 39健康网 39健康网

术后三个月的他就已回到工作岗位,日常生活业回归正常轨迹。回首这段往事,陈先生至今仍记忆犹新。

阳江的陈先生最近在暨南大学附属第一医院完成膀胱根治性切除术后的第二年复查,检查提示肿瘤没有复发,各项指标也恢复良好,令人欣喜的是,他术后不但恢复了自主排尿,性功能也基本恢复到术前水平。

其实,术后三个月,陈先生就已回到工作岗位,日常生活也回归正常轨迹。回首这段往事,陈先生至今仍记忆犹新。

延续半年的无症状血尿 真凶是膀胱上长的肿瘤

陈先生两年多前开始出现间断血尿,然而并无疼痛等不舒服,多喝些水后血尿也能减轻,于是没有引起重视,折腾半年后他才到当地医院就诊,经过超声和磁共振检查发现原来竟是膀胱长了肿瘤。

经过一系列检查后,主诊医生告诉他,因为肿瘤已经体积比较大,并且已经侵犯了全层的膀胱壁,需要将整个膀胱进行切除才有可能治愈。

但是按照传统的手术方法,陈先生手术之后将终生携带尿袋生活,并且面临术后性功能障碍的尴尬处境。这可让正值壮年的苏先生陷入了深深的焦虑和纠结之中,有没有办法既能治好肿瘤,又能保留正常的生理机能,术后最大程度回归正常的生活呢?

陈先生慕名找到了暨南大学附属第一医院泌尿外科赖彩永主任医师,经过全面的检查后,赖彩永于2019年1月为陈先生施行了保留性神经的腹腔镜下膀胱根治性切除+回肠原位新膀胱手术,经过五个半小时的手术,将长有肿瘤的膀胱彻底切除,同时采用一段小肠重建了一个新膀胱。

赖彩永教授正为患者做膀胱根治性切除术

术后两个星期拔除尿管,术后两个月左右开始晨勃也逐渐恢复,欣喜的是术后三个月左右,陈先生便逐步恢复了自主排尿,而在术后五个月左右在药物的辅助下,陈先生的排尿和性功能基本恢复。

无痛血尿是膀胱癌的信号 出现血尿应该及时就诊

据赖彩永教授介绍,膀胱癌是男性常见的肿瘤之一,常见于中老年人,间隙性无痛性肉眼血尿是膀胱癌常见的症状。

由于血尿可自行停止,容易被忽视,应引起大家的重视,一旦出现血尿需要及时到医院就诊,首选行泌尿系的超声检查,另外,作为平时的健康体检,也推荐一年一次的超声检查,可以发现早期肿瘤。

早期的膀胱癌,绝大多数可通过尿道膀胱肿瘤切除手术保留膀胱,对生活影响小。而对于侵犯膀胱肌层的膀胱肿瘤或者高危浅表的膀胱肿瘤,则需要进行膀胱全切除有可能治愈肿瘤。

传统的手术方法由于切除的范围广泛,手术后病人不但有面临需要尿流改道,终生使用尿道的困境,并且约90%术后出现阴茎勃起功能障碍(俗称阳痿),往往令很多病人难以接受,这也是这一领域面临的世界性难题。

“如何能够在彻底切除肿瘤病灶的同时,最大程度保留排尿和性功能”,是赖彩永这几年重点在研究的课题,随着手术设备的改进和对于盆腔膜解剖的认识不断深入,通过几年的探索和实践,赖教授课题组在这一领域创新性提出预先显露并全程保护性神经和供应阴茎的动脉血管,取得令人满意的结果。

据赖彩永介绍,对于性功能正常的中期膀胱肿瘤患者,目前在经历膀胱全切除后,通过腹腔镜手术中对性神经和阴茎血管的保护,近三年的手术随访结果显示术后不但瘤控良好,并且均能恢复自主排尿, 80-90%术后在半年内能恢复勃起功能。

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    2021-01-20 ms5000000295490355

    不知道患者预后如何

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    2021-01-20 留走人康

    膀胱癌真怪,明明是免疫敏感性肿瘤,为什么PD-1治疗效果不好呢?难道靶点不对?将来CD47会不会有效

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    2021-01-20 ms4000000849873701

    ?

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