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食管癌和胃癌的微创手术现状

Present state of the Mini-Invasive Surgery (MIS) in esophageal and gastric cancer.

作者信息

Azagra J S, Goergen M, Lens V, Ibáñez-Aguirre J F, Schiltz M, Siciliano I

机构信息

Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg.

出版信息

Clin Transl Oncol. 2006 Mar;8(3):173-7. doi: 10.1007/s12094-006-0007-y.

Abstract

The purpose of this review is to stress the role of the Mini-Invasive Surgery (MIS) in the treatment of the esophagogastric malignant illnesses, supporting ourselves on the most relevant publications of the literature as well as on our own experience in this subject. In short, although no randomised prospective study has proven the MIS advantages in relation to the traditional surgery in the esophagectomy due to cancer, some authors preferently indicate this approach to selected and informed enough patients, who present the following: - High grade dysplasia, preferently choosing from laparoscopic transhiatal esophagectomy (LTE). - Carcinoma in situ, preferently choosing the LTE vs thoracoscopy. - Esophageal tumour locally advanced, in resectable patients with contraindication for a thoracotomy or, in initially non-resectable patients with tumoral reduction after neo-adjuvant chemo-radiotherapy. The arguments given by the authors are the postoperative spectacular improvement in relation to the comfort and quality of life and, the absence of oncological negative effects in the long-term followup. Concerning gastric cancer, the MIS, as exeresis surgical tool in the so-called <> gastric forms, is such a definite and oncological approach as the traditional approach, and superior to this as far as quality of life is concerned. When the MIS is used for treating locally advanced forms of gastric cancer, it is as safe as the laparotomic way and it seems to obtain the same oncological outcomes in the long-term.

摘要

本综述的目的是强调微创手术(MIS)在食管胃恶性疾病治疗中的作用,依据该领域最具相关性的文献出版物以及我们自身在此方面的经验。简而言之,尽管尚无随机前瞻性研究证实MIS在因癌症进行食管切除术时相对于传统手术的优势,但一些作者更倾向于向符合以下条件且充分了解情况的特定患者推荐这种手术方式:- 高级别异型增生,优先选择腹腔镜经裂孔食管切除术(LTE)。- 原位癌,优先选择LTE而非胸腔镜手术。- 局部晚期食管肿瘤,适用于有开胸手术禁忌证的可切除患者,或在新辅助放化疗后肿瘤缩小的初始不可切除患者。作者给出的理由是,与传统手术相比,MIS术后在舒适度和生活质量方面有显著改善,且在长期随访中没有肿瘤学方面的负面影响。关于胃癌,MIS作为所谓“进展期”胃癌的切除手术工具,与传统手术一样是一种明确的肿瘤学手术方式,并且在生活质量方面优于传统手术。当MIS用于治疗局部进展期胃癌时,其安全性与开腹手术相当,且从长期来看似乎能获得相同的肿瘤学疗效。

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