腹腔镜结直肠癌治疗进展.ppt

ASCRS关于下切缘 Huashan Hospital Hao Hankun Dis Colon Rectum 2013; 56: 535–550 A 2-cm distal mural margin is adequate for most rectal cancers when combined with a TME. For cancers located at or below the mesorectal margin, a 1-cm distal mural margin is acceptable. Grade of Recommendation: Strong recommendation based on moderate quality evidence, 1B. 植物神经保护 Huashan Hospital Hao Hankun 植物神经保护 Huashan Hospital Hao Hankun 医学百事通，咨询医师 植物神经保护 Huashan Hospital Hao Hankun 植物神经保护 Huashan Hospital Hao Hankun 植物神经保护 Huashan Hospital Hao Hankun 肿瘤学原则： 充分的切缘 功能学原则： 良好的括约肌功能 医生的选择： 技术难度、潜在风险 患者的选择： 充分的医患沟通 LAR, ISR or APR? Huashan Hospital Hao Hankun Company Logo 腹腔镜辅助结直肠癌根治术 医学百事通转载 刘志华医师-直肠癌治疗 主要内容 腹腔镜结直肠癌根治是否可行？ 1 如何行腹腔镜结直肠癌根治术？ 2 Huashan Hospital Hao Hankun 腹腔镜发展史 Huashan Hospital Hao Hankun 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 腹腔镜结直肠手术发展 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. 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. 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) Huashan Hospital Hao Hankun 腹腔镜与结肠癌 COST的结果 N Engl J Med 2004;350:2050-9. Huashan Hospital Hao Hankun 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. 腹腔镜与结肠癌 COLOR的结果 Less blood loss Radicality of resection not di