郑民华微创手术能否成为胃肠肿瘤手术的金标准微创手术能否成为胃肠肿瘤手术的金标准ppt课件.ppt

* * * * * * * * * * * * * * * * * * 能成为金标准吗? 手术技术已经成熟 循证已有部分依据 患者大部分能接受 但需规范培训后推广 但需更多的RCT What is the future in China? Laparoscopic Surgery Endoscopic Surgery Single Port Surgery Robotic Assisted Surgery NOTES Laparo-endoscopic Surgery En-bloc resection Non-touch tumor technique Adequate surgical margin Radical lymphadenectomy Principle 革命尚未成功 同志尚需努力 * * * * * * 5 * * * * * Now, the incidence of intraoperative and postoperative complication seems to decrease every year, as shown in the national survey by JSES. * * * As to the results of laparoscopic surgery for early cancer, we have reported them in “Annals of Surgery” in 2007. We demonstrated that laparoscopic gastrectomy was feasible as a treatment for early gastric cancer. * * This slide shows histological stages where the patients underwent laparoscopic gastrectomy were at. 43% of patients had stage IB disease, 37% had stage II disease and 12% had stage IIIA disease. * This slide shows operative complications after LADG for advanced cancer. The incidence of intra-operative and post-operative complications was 1.7% and 13.8%. From the view points of technical feasibility, LADG for advanced cancer appears to be as safe as the one for early cancer. * * The 5-year disease free survival rate was 82% in patients with advanced gastric cancer (T2N0 and T2N1) underwent LADG. * And we have just kicked off RCT by multi-centers to evaluate oncological feasibility of LADG for advanced cancers. * * * At present, so far, Japanese Guideline of Treatment for Gastric Cancer recommends that the indication of LADG should be considered as an early cancer (T1N0). Recently, LADG has come to be good for the treatment of T1N1, T2N0 and T2N1 cancers because of development of lap. D1+β and D2 lymph node dissection. * 腹腔镜结直肠癌中转开腹指证 中国目前标准 在腹腔镜手术过程中，确实因出于病人安全考虑而须行开腹手术者 术中发现肿瘤在腹腔镜下不能切除或肿瘤切缘不充分者 美国 (COST) 参考标准 遇到如下情况时，由手术医师根据患者安全考虑决定是否需中转开腹： 1. 技术上操作困难 2. 条件限制 3. 无法获得充分肿瘤切缘 国际现行标准 腹腔镜结直肠癌手术标准 美国 (NCCN) 英国 (