结肠癌治疗的微创技术.docVIP

结腸癌治療的微創技術 Minimally Invasive Therapy for Colorectal Cancer 蒙家興 MENG Chia Shing, William 香港 東華三院 廣華醫院（香港） Kwong Wah Hospital, Kowloon, HONG KONG, SAR PRC. 中图分类号：R735.3+5 文献标识码：A 文章编号：1818－02086（2008）03 摘 要：香港發展微創結腸手術已有十六年的历史經驗，腹腔鏡結直腸癌切除手術，成績最為顯注。最近陸續有大型的、權威性的研究報告指出，腹腔鏡手術跟傳統手術相比：康復較快、胃腸功能恢復較早、住院時間較短、併發症較少。隨訪資料亦顯示微創手術的復發機會較低、長期存活率較高。 經肛內窺鏡顯微手術(TEM)，是另一最新發展項目。是對直腸的早期癌症及絨毛腺性瘤的微創手術，手術於直腸內進行，完全沒有表面傷口，除了日本外，香港是東南亞唯一的研究中心。 最近文獻發表了TEM加輔助放化療在治療T2及T3直腸癌的成效，相當令人鼓舞。因此，“保直腸療法”的概念，亦即類似乳癌治療的“保乳手術”，應運而生。一方面，我們考慮擴大手術適應證，治療比較後期的T2及T3直腸癌；另一方面，具備了無切口和低并發率的優勢，在治療早期直腸癌Tis、 T0及T1方面，TEM將會挑戰目前的金標準全直腸系膜切除術（TME）。 另外內鏡成像技術亦發迅速，新技術有：染色內鏡(chromoendoscopy)，窄帶成像技術（narrow band imaging (NBI) ）和自體熒光成像技術（autofluorescence (AFI) imaging）。 而直腸超聲(TRUS)和超聲內鏡(EUS)在癌病分期分面則越來越準確。微創手術已進入了一個新階段，结合內鏡(Endoscopy)、微創手術(Minimally Invasive Surgery)及介入放射學 (Interventional Radiology)，開創了(Endo-Minimally Invasive Therapy) EndoMIT綜合治療的新局面。 关键词: 微創手術；結腸；腹腔鏡手術；經肛內窺鏡顯微手術 Introduction We celebrated the 15th anniversary of the first minimally invasive surgery for colorectal carcinoma in Hong Kong last year. Since 1992, there were quite a number of exciting developments in the field of colorectal surgery. With the advances of instruments and acquisition of expertise in techniques, minimal access surgery has gained more popularity. In colorectal surgery, we have explored the all the possibilities of laparoscopic operations in the whole of the hindgut. It included laparoscopic assisted colon and rectum resection, laparoscopic total mesorectal excision and hand assisted laparoscopic colectomy. For treatment of rectal villous adenoma and also early carcinoma of the rectum, Transanal Endoscopic Microsurgery (TEM) enabled endoluminal surgery through a one-port system via a natural orifice, the anus. This technique combined the microsurgery, endoscopy and laparosocpic surgical technique. As one of the first centres in Southeast Asia to develop Transanal Endoscopic Microsurgery (TEM), we are glad to announce that recently the