摘要
为了让结直肠癌患者得到更大的微创获益,外科医师一直在尝试单孔腹腔镜和经自然腔道内镜等手术方式,大量单孔手术操作平台和单孔可弯曲器械的问世也让该项技术的临床应用成为可能.虽然现在已经有许多单中心小样本的研究结果证明单孔腹腔镜在结直肠癌治疗方面可以获得与传统腹腔镜相似的短期肿瘤学效果,并且有望得到更小的创伤和更好的美容效果,但到目前为止仅有4项相关的前瞻性临床研究很难让其优势获得强有力的循证医学证据支持.究其原因主要是经自然腔道内镜和纯单孔腹腔镜手术操作难度大、学习曲线时间长,很多外科医师难以坚持或望而却步.因此,现今多数腹腔镜外科医师在追求腹腔镜微创技术极致的同时,也在逐渐关注技术的可学习性及易推广性.在纯单孔手术的基础上增加一个操作孔,解放了术者的主要操作器械,在最大程度上保持单孔手术微创性的同时,可大幅度降低手术难度,增加可操作性.
For further maximizing the minimally invasive benefits for colorectal cancer patients, laparoscopic surgeons have been dedicating to improve the surgery through single-port （SILES） or natural orifice transluminal endoscopic surgery （NOTES）, which is supported by amount of single-port devices and flexible laparoscopic instruments.Many small sample studies of single institution have suggested that SILES for colorectal cancer has similar oncological outcomes with conventional laparoscopic surgery （CLS）, could improve the cosmetic results, and is more minimally invasive than CLS. However, evidences of advantages for SILES are limited, because of there has been only 4 published studies of prospective randomized clinical trial so far. Due to the technical difficulties and long learning curves, SILES and NOTES are relatively hard to be widely promoted. Thus, a balance between minimally invasive pursuit and laparoscopic technical challenge should be sought. In this way, modified SILES and reduced-port laparoscopic surgery have emerged in recent years, which might be minimally invasive solutions with lower technical demanding for laparoscopic colorectal cancer surgeries. Adding a port as the surgeon′s dominant operation channel improved the collisions or overlapping of instruments with movement to reduce the technical difficulties. SILS＋1 is safe and feasible, would be supported by more and more evidences.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2017年第7期486-490,共5页
Chinese Journal of Surgery
