中国普外基础与临床杂志

中国普外基础与临床杂志

减孔腹腔镜直肠癌根治术临床研究新进展

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目的 了解减孔腹腔镜直肠癌手术的技术实现情况、开展现状、面临问题及应用前景,分析并比较其安全性与可行性,为临床应用和推广提供理论和实践依据。 方法 通过检索 Medline、Embase、中国知网、万方等数据库,收集减孔腹腔镜直肠癌手术相关的文献并进行综述。 结果 目前探索最多的减孔腹腔镜主要是单孔腹腔镜手术、2 孔腹腔镜手术及 3 孔腹腔镜手术。单孔腹腔镜直肠癌手术具有明显的微创美容效果,但是操作难度较大;2 孔腹腔镜直肠癌手术可最大程度地保持单孔腹腔镜直肠癌手术微创性的同时,大幅度降低了手术难度,易于学习及推广;3 孔腹腔镜直肠癌手术经验的积累有助于 SILS 的开展,但是没有较好地利用取标本的辅助切口。可见减孔腹腔镜直肠癌手术安全、可行,可以在保证肿瘤根治的同时具有与常规 5 孔腹腔镜或开腹手术相当甚至更好的短期疗效。但是减孔腹腔镜对腹腔镜操作技术要求较高,还需要克服一定的学习曲线。 结论 减孔腹腔镜直肠癌手术具有较常规五孔腹腔镜更微创、更美容、恢复更快等显著优势,但其安全性、可行性、肿瘤学预后等亟待更多高质量的大样本、多中心随机临床试验来进一步验证。

Objective To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery of rectal cancer, and to compare their safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion. Method By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery were collected and reviewed. Results At present, the most common reduced-port laparoscopic surgery was the one-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The one-port laparoscopic surgery had the effect of minimal invasiveness and cosmesis, but it was difficult to perform. While the single-incision plus one-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly. Consequently, the single-incision plus one-port laparoscopic surgery was easy to learn and promote. The experience of the three-port laparoscopic surgery for rectal cancer contributed to the technical development of SILS. However, the assisted incision for intraoperative specimen was not well applied to three-port laparoscopic surgery. The reduced-port laparoscopic surgery of rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for laparoscopic surgery was demanded. It was also necessary to overcome the learning curve. Conclusions Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery, which attracts really attention of laparoscopic surgeons to perform extensively clinical research. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery of rectal cancer.

关键词: 直肠癌; 根治手术; 微创直肠手术; 减孔腹腔镜手术

Key words: rectal cancer; radical resection; minimally invasive rectal surgery; reduced-port laparoscopic surgery

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