中国腹腔镜直肠癌手术30年历程与成就

1991年,第一例腹腔镜手术在中国大陆实施以来,微创手术在全国蓬勃兴起,技术及设备的量级提升使得微创、精准医学理念得到了实现。30年来,从2D,3D,HD到4K,成像设备不断升级,从经典的“五孔法”到“单孔法”腹壁创伤不断减少,从经腹入路到经肛门直肠全系膜切除术(TaTME)手段不断丰富,腹腔镜手术目前已经发展成为治疗直肠癌的成熟模式。与开腹手术相比,腹腔镜手术的优势明显,从根治性切除到功能保护,微创理念一以贯之,治愈率和保肛率均显著提高。在中国外科同道的共同努力下治疗理念和手术技术不断革新和进步。近年来我国学者提出的经自然腔道取标本手术(NOSES),在严格的指征把握下,该类手术将微创做到了极致,不增加术后并发症,并取得了满意的近期、远期临床效果,使患者无论在心理上还是生理上都得到了最大程度获益。在手术机器人逐渐普及的时代,相信在术中立体影像技术的导航下,未来的腹腔镜直肠癌手术将更为精准且模式化,为人类造福。

Evolution and achievements of laparoscopic rectal cancer surgery in China in the past 30 years

Since 1991,the first case of laparoscopic cholecystectomy was performed in Chinese mainland,minimally invasive surgery has been booming in our country.With the upgrading level of technology and equipment,the concept of minimally invasive and precise medicine has been realized.In the past 30 years,from 2D,3D,HD to 4K,imaging equipment has been constantly upgraded.From the classic"five hole method"to the"single hole method",the abdominal trauma has been continuously reduced.From the abdominal approach to the transanal approach in the Total Mesocolic Excision(TME),laparoscopic surgery has been developed as a matural mode for the surgical treatment of rectal cancer.Compared with open surgery,laparoscopic surgery has obvious advantages.From radical resection to functional protection,minimally invasive concept is consistent,and the cure rate and anal preservation rate are significantly improved.With the joint efforts of Chinese surgical colleagues,the treatment concept and surgical techniques have been constantly innovated and improved,.In recent years,the Natural Orifice Specimen Extraction Surgery(NOSES)has been proposed by Chinese scholars,under the strict indications,this kind of operation will achieve the ultimate minimally invasive effect,without increasing postoperative complications,and could achieve satisfactory short-term and long-term clinical outcome,therefore patients could be benefit psychologically and physiologically.In the era of robot-assisted surgery and artificial intelligence(AI),it is believed that under the guidance of intraoperative stereo imaging technology,laparoscopic rectal cancer surgery in the future will be more accurate and patterned,which will benefit all of mankind.