医学百事通，在线医生咨询
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Huashan Hospital Hao Hankun
NCCN指南的变化 11
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Huashan Hospital Hao Hankun
腹腔镜结直肠手术的主要适应证和禁忌证
• 适应证：
– 腹腔镜手术适应证与传统开腹手术相似。包括结肠良恶性 肿瘤、炎性疾病、多发性息肉等；
N Engl J Med 2004;350:2050-9. 7
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Huashan Hospital Hao Hankun
腹腔镜与结肠癌
❖COLOR的结果
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Huashan Hospital Hao Hankun
Less blood loss
Radicality of resection not
Huashan Hospital Hao Hankun
腹腔镜面临的质疑
❖ Lancet. 1994 344(8914):58. Subcutaneous metastases after laparoscopic colectomy. Berends FJ, Kazemier G, Bonjer HJ, Lange JF.
腹腔镜辅助结直肠癌根治术
主要内容
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Huashan Hospital Hao Hankun
1
腹腔镜结直肠癌根治是否可行？
2
如何行腹腔镜结直肠癌根治术？
2
腹腔镜发展史 3
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Huashan Hospital Hao Hankun
腹腔镜结直肠手术发展
❖ 1991年 Flower和Jacobs行腹腔 镜乙状结肠切除术
❖ 1992年 Kokerling首次施行腹腔 镜Miles手术
❖ 1993年 Watanabe日本首例腹 腔镜结肠手术
❖ 1994年 Leahy首次报告手助腹 腔镜手术
❖ 1995年 香港郭宝贤完成亚洲首 例乙状结肠手术
❖ 1997年 上海郑民华完成内地首 例乙状结肠手术
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5
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Huashan Hospital Hao Hankun
腹腔镜医生迎接挑战
❖ COST (Clinical Outcomes of Surgical Therapy)
❖ COLOR (COlon cancer Laparoscopic or Open Resection)
❖ CLASICC(Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer)
❖ Br J Surg. 1994 81(5):648-52. Abdominal wall metastases following laparoscopy. Nduka CC1, Monson JR, Menzies-Gow N, Darzi A.
❖ Br J Surg. 1994 81(11):1697. Abdominal wall metastases following laparoscopy. Prasad A, Avery C, Foley RJ.
used for safe and radical
resection of cancer in the right,
left, and sigmoid colon.
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Lancet Oncol 2005; 6: 477–84
ASCRS Practice Parameters (2012)
Laparoscopic and open colectomy achieve equivalent oncological outcomes for localized colon cancer. The use of the laparoscopic approach should be based on the surgeon’s documented experience in laparoscopic surgery as well as on patient- and tumor-specific factors. Grade of Recommendation: 1A
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Huashan Hospital Ha的结果
Conclusions In this multi-institutional study, the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.
Dis Colon Rectum 2012; 55: 831–843 9
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Huashan Hospital Hao Hankun
NCCN指南的变化
❖ 拒绝：费用昂贵，术后恢复时间与开腹手术没有区别，且 缺乏相关生存数据，不推荐临床常规使用。
❖ 部分接受：①要求术者具有丰富的腹腔镜手术经验；②无 直肠或远端结肠肿瘤；③无远处转移、无梗阻或穿孔、无 腹腔粘连；④要求术者对腹腔全面探查；⑤较小的肿瘤术 前需要定位。
differ
Earlier recovery of bowel
function
Fewer analgesics
Shorter hospital stay
Morbidity and mortality 28
days after colectomy did not
differ
Conclusion：
Laparoscopic surgery can be
• 相对手术禁忌：
– 肿瘤直径大于6cm或/和与周围组织广泛侵润； – 腹部严重粘连、重度肥胖者、大肠癌的急症手术（如急性梗阻、