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[微创技术在结直肠癌手术中的进展]

[Advances of minimally invasive technique in colorectal cancer surgery].

作者信息

Wang Xishan

机构信息

Department of Colorectal Surgery, National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Jun;19(6):621-3.

Abstract

Colorectal surgery is rapidly developing in the direction of minimally invasive surgery and functional surgery. New technology and ideas are constantly emerging recently. Laparoscopic colon surgery has already been recommended by NCCN guideline. However, laparoscopic rectal cancer surgery still needs to wait for survival and recurrence rates of long-term follow-up data for verification. In recent years, with the rapid progression of imaging equipment of laparoscope, the new 3D laparoscopic system will process image more quickly, and surgeons can get space depth feeling like open surgery only with a pair of glasses. The new 3D laparoscopic system has many advantages, and can also shorten the learning curve of the beginners. But it does not mean the traditional 2D laparoscopy has been out of date. It is admitted that dialectical view on the development of the technology and equipment is still required. New things also need the accumulation of time and validation, and the deficiency of imaging system remains to be improved. At present, the robotic colorectal cancer surgery is still in its infancy, and its application is relatively common in colon surgery. In respect of robotic rectal cancer surgery, it still lacks of long-term follow-up survival results for verification. To reduce physical and psychological trauma for patients is the goal of the surgeon. Surgeons are experiencing the change from minimally invasion to non-invasion. Natural orifice translumenal endoscopic surgery (NOTES) and natural orifice specimen extraction surgery (NOSES) arise at the historic moment. Among them, transanal total mesorectal excision (taTME) incorporates the concepts of NOTES, anal minimally invasive surgery and total mesorectum excision, guaranteeing the radical cure and no scar of abdomen, but it still needs multicenter, large sample and long-term follow-up clinical data to prove its safety, efficacy and indication. Therefore, surgical procedure is transforming from conventional laparoscopic surgery to the NOTES and NOSES. The surgical principle is the eternal cornerstone to ensure the radical tumor resection and the safety of patients.

摘要

结直肠手术正迅速朝着微创手术和功能手术的方向发展。近年来,新技术和理念不断涌现。腹腔镜结肠手术已被美国国立综合癌症网络(NCCN)指南推荐。然而,腹腔镜直肠癌手术仍需等待长期随访数据的生存率和复发率来验证。近年来,随着腹腔镜成像设备的迅速发展,新型3D腹腔镜系统将更快地处理图像,外科医生仅需戴上一副眼镜就能获得像开放手术一样的空间深度感。新型3D腹腔镜系统有许多优点,还能缩短初学者的学习曲线。但这并不意味着传统的二维腹腔镜已经过时。人们承认,仍需要以辩证的观点看待技术和设备的发展。新事物也需要时间的积累和验证,成像系统的不足仍有待改进。目前,机器人辅助直肠癌手术仍处于起步阶段,其在结肠手术中的应用相对普遍。在机器人辅助直肠癌手术方面,仍缺乏长期随访生存结果来验证。减少患者的身心创伤是外科医生的目标。外科医生正在经历从微创到无创的转变。经自然腔道内镜手术(NOTES)和经自然腔道标本取出手术(NOSES)应运而生。其中,经肛门全直肠系膜切除术(taTME)融合了NOTES、肛门微创手术和全直肠系膜切除的概念,保证了根治性切除且腹部无瘢痕,但仍需要多中心、大样本及长期随访的临床数据来证明其安全性、有效性及适应证。因此,手术方式正从传统的腹腔镜手术向NOTES和NOSES转变。手术原则是确保肿瘤根治性切除和患者安全的永恒基石。

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