手辅助腹腔镜手术在胃肠外科中的应用及适应证选择

尽管传统腹腔镜技术在胃肠道良恶性疾病中的应用逐步获得广泛的认可，但仍有学习曲线延长、手术时间延长、技术难度增加以及肥胖患者手术复杂性等不足。手辅助腹腔镜技术（HALS）作为介于开腹手术与腹腔镜手术的一种杂交技术．由于恢复了手的触觉以及手眼协调．弥补了传统腹腔镜手术的不足．同时部分保留了传统腹腔镜手术的微创优势，且手术时间及学习曲线明显缩短．在肥胖患者及复杂的胃肠手术中具有一定优势。但HALS手术也存在手对术野的阻挡和手疲劳等不足．HALS治疗恶性肿瘤的近远期疗效尚待更多的循证学研究加以证实。

Application and indication choice of hand-assisted laparoscopic operation in gastrointestinal surgery

Despite gaining wider popularity in the management of both benign and malignant gastrointestinal diseases over the past decade, traditional laparoscopic surgery remains to be associated with several distinct disadvantages, including longer operative time, longer learning curve, technical difficulty in obese patients and complicated cases. As a hybrid technique between open surgery and traditional laparoscopic surgery, hand-assisted laparoscopic surgery （HALS） brings back tacktile feeling and hand-to-eye coorrdination to surgeons. It allows surgeons to perform more complicated gastrointestinal surgery, while retaining the merits of traditional laparoscopic surgery. It also improves operative time and learning curve. The main disadvantages of HALS seem to be the hindering effect and fatigue of the inserted hand. The exact role of HALS in gastrointestinal surgery has not been well defined due to lack of substantial evidences from clinical trials.