食管癌的微创术

Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.     

食管癌微创外科治疗的发展与现状

食管癌微创外科治疗有望解决传统食管癌手术创伤大,术后生命质量差的问题。随着胸腔镜、腹腔镜等设备和技术的发展以及肿瘤治疗理念的更新,食管癌的微创外科治疗近年来取得了较大进展。     

低频超声联合手术在食管癌治疗中的应用

目的探讨低频超声联合手术治疗对食管癌患者生存的影响。方法 80例食管癌患者随机分为2组,每组40例。研究组40例接受低频超声联合手术治疗,对照组40例仅进行手术治疗。结果研究组1、2、3 a生存率分别为80.3%、62.5%、40.9%,对照组分别为75.3%、55.1%、36.8%,2组比较差异均有统计学意义(P<0.05)。2组并发症发生率比较差异无统计学意义(P<0.05)。研究组淋巴结肿瘤细胞存活率为21.5%,低于对照组的37.3%,差异有统计学意义(P<0.05)。结论低频超声联合手术治疗能够改善食管癌患者的生存状况,且不增加患者的术后并发症,值得在临床推广应用。     

食管癌外科治疗进展

外科是食管癌的主要治疗手段之一,近年来出现了一些新理念和新技术,主要表现在以下方面：①右侧开胸手术有代替左侧开胸的趋势;②更加注重喉返神经周围淋巴结清扫;③食管癌三野淋巴结清扫的开展;④管状胃的应用;⑤食管癌微创手术的开展;⑥术前新辅助化疗或新辅助放化疗的研究。     

Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

BACKGROUND: The use of minimally invasive surgery (MIS) in pediatric cancer is a matter of debate. The diagnostic and ablative roles of MIS were evaluated in a consecutive series of children with malignancies. METHODS: A prospective study, including all patients, who underwent abdominal and thoracic surgery for confirmed or highly suspected pediatric cancer was performed from September, 2000, to December, 2005. An interdisciplinary panel approved the indication for minimally invasive or conventional surgery. RESULTS: At a single institution, 301 operations were performed on 276 children with cancer. A minimally invasive approach was attempted in 90 of these patients (30%) and successfully employed in 69 (77%) of the operations. However, 21 operations (23%) were converted to an open approach. Regarding the abdominal operations attempted laparoscopically, 41 abdominal operations for biopsy or staging purposes were attempted laparoscopically (53%), but 6 were converted. In all, 139 abdominal resections were performed and 24 were attempted laparoscopically. Ten of these (42%) were converted. In 34 thoracic operations requiring biopsy, thoracoscopy was attempted in 14 (41%) and was successful in all but 1 (93%). Fifty-one thoracic tumors were resected and the thoracoscopic approach was attempted in 11 (22%) and successful in 7 (14%). Conversions from a minimally invasive operation to an open procedure occurred mainly due to limited visibility. Three bleeding complications occurred with 1 patient requiring a blood transfusion. In addition, 1 small bowel injury occurred with immediate laparoscopic closure. There were no port site recurrences after a median of 39 months. CONCLUSIONS: MIS is a reliable diagnostic tool for pediatric abdominal and thoracic malignancy. The role of ablative MIS in pediatric cancer remains limited.     

保留左结肠动脉对直肠癌微创手术效果的影响

目的探讨保留左结肠动脉(LCA)对直肠癌微创手术效果的影响。方法将行微创手术治疗的直肠癌患者58例,根据手术时是否保留LCA分为保留组(n=31例)和未保留组(n=27例)。收集患者病例资料,观察比较2组患者的一般情况、围手术期情况和术后复发转移情况。结果 2组患者性别、年龄、肿瘤长径、距肛缘距离、病理类型、TNM分期比较,差异无统计学意义(P>0.05)。2组患者围手术期术中出血量、术后排气时间、吻合口出血发生率比较,差异无统计学意义(P>0.05);保留组手术时间较未保留组长(P<0.05);双腔造口比例、吻合口漏发生率较未保留组低(P<0.05)。2组患者术后复发和转移率比较,差异无统计学意义(P>0.05)。结论保留左结肠动脉能够改善直肠癌微创手术患者结肠残端的血供,降低预防造口比例和吻合口漏的发生率,且对患者预后无明显影响。     

Comparison of Perioperative and Oncologic Outcomes with Laparotomy,and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer

Purpose: To compare perioperative outcomes and oncologic outcomes in endometrial cancer patients treatedwith laparotomy, and laparoscopic or robotic surgery. Materials and Methods: Endometrial cancer patients whounderwent primary surgery from January 2011 to December 2014 were retrospectively reviewed. Perioperativeoutcomes, including estimated blood loss (EBL), operation time, number of lymph nodes retrieved, and intraand postoperative complications, were reviewed. Recovery time, disease free survival (DFS) and overall survival(OS) were compared. Results: Of the total of 218 patients, 143 underwent laparotomy, 47 laparoscopy, and 28robotic surgery. The laparotomy group had the highest EBL (300, 200, 200 ml, p<0.05) while the robotic grouphad the longest operative time (302 min) as compared with laparoscopy (180 min) and laparotomy (125 min)(p<0.05). Intra and postoperative complications were not different with any of the surgical approaches. Nosignificant difference in number of lymph nodes retrieved was identified. The longest hospital stay was reportedin the laparotomy group (four days) but there was no difference between the laparoscopy (three days) and robotic(three days) groups. Recovery was significantly faster in robotic group than laparotomy group (14 and 28 days, p=0.003). No significant difference in DFS and OS at 21 months of median follow up time was observed among thethree groups. Conclusions: Minimally invasive surgery has more favorable outcomes, including lower blood loss,shorter hospital stay, and faster recovery time than laparotomy. It also has equivalent perioperative complicationsand short term oncologic outcomes. MIS is feasible as an alternative option to surgery of endometrial cancer     

Robotic and minimal access surgery: technology and surgical outcomes of radical prostatectomy for prostate cancer

Since the 1990s, minimal access surgery has been utilized in urology. In the past 15 years, robotic surgery has evolved and become a natural part of minimal access surgery. The dissemination has been fast and the opportunity of prospective trials has been missed. Nevertheless, robotic surgery has obvious benefits for the surgeon and patient. Even though the scientific evidence is not strong, robotic surgery is here to stay. However, there are lessons to learn from the implementation of the da Vinci system with regards to patient safety and prospective evaluation of the new technology. The future of surgery will include technologies derived from robotic surgery.     

食管癌的新辅助治疗

Because the conflicting data currently available from the performed randomized trials it is very difficult to provide strict guidelines for the treatment of patients with locoregional advanced esophageal cancers. Surgery however, remains the standard of care for potentially resectable disease. Preoperative chemotherapy is still controversial with two large randomized trials resulting in two different conclusions regarding the survival benefit. Preoperative chemoradiation is also controversial since only one randomized trial showed a clear survival benefit however, the patients treated with surgery alone in this trial had an unusually poor outcome. And the study by Urba et al was not powered enough to show a clear survival benefit for patients treated with neoadjuvant chemoradiation. The results of three metaanalysis of these randomized studies show lower rate of resection, higher rate of R0-resection, more often postoperative mortality and better prognosis for patients with neoadjuvant radiochemotherapy. As a consequence one may consider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locallyadvanced disease under the premise that patients have a good performance status and understand the controversies about this therapeutic option. Larger trials with sufficient power to clearly detect survival benefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary before this therapeutic option will be the standard of care.     

Neoadjuvant Treatment for Esophageal Cancer

Because the conflicting data currently available from the performed randomized trials it is verydifficult to provide strict guidelines for the treatment of patients with locoregional advanced esophagealcancers.Surgery however,remains the standard of care for potentially resectable disease.Preoperativechemotherapy is still controversial with two large randomized trials resulting in two different conclusionsregarding the survival benefit.Preoperative chemoradiation is also controversial since only one randomizedtrial showed a clear survival benefit however,the patients treated with surgery alone in this trial had anunusually poor outcome.And the study by Urba et al was not powered enough to show a clear survivalbenefit for patients treated with neoadjuvant chemoradiation.The results of three metaanalysis of theserandomized studies show lower rate of resection,higher rate of RO-resection,more often postoperativemortality and better prognosis for patients with neoadjuvant radiochemotherapy.As a consequence one mayconsider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locally-advanced disease under the premise that patients have a good performance status and understand thecontroversies about this therapeutic option.Larger trials with sufficient power to clearly detect survivalbenefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary beforethis therapeutic option will be the standard of care.     

淋巴导航技术在胃癌微创手术中的研究进展

规范化D2淋巴结清扫与手术后标本精细分拣淋巴结相结合可以提高胃癌患者生存并达到精准分期的目的。随着不同淋巴示踪剂的广泛应用,个体化淋巴导航正在成为胃癌微创手术中新的技术突破。淋巴结示踪技术是提高术中淋巴结清扫质量以及纠正术后病理分期偏倚的重要手段。本文将就此技术的应用现状及进展作一综述。     

腔镜辅助微创手术治疗甲状腺良性肿瘤

目的:探讨腔镜辅助小切口甲状腺良性肿瘤手术的微创及美容的临床价值。方法:2009年9月至2010年10月,我院住院的218例甲状腺结节患者,分为腔镜辅助微创手术组109例,传统手术组109例作为对照组。结果:218例手术均顺利完成,手术时间两组无明显差异(P>0.05)。术中出血微创组少于传统组(P<0.01)。术后引流量微创组明显少于对照组(P<0.01),美容满意度微创组明显优于传统组(P<0.01)。无并发症发生。病理结果均为良性病变,病理报恶性者改变术式,不在统计范围。结论:对于大多数良性甲状腺疾病,腔镜辅助小切口甲状腺手术是一种创伤小、有一定美容效果、病人易于接受的手术治疗方法。