腹腔镜辅助结直肠癌根治术.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 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 LAR or ISR? LAR指征： 肿瘤下缘距离齿状线大于3cm 无括约肌和周围脏器侵犯 双吻合器 ISR指征： 肿瘤下缘距离齿状线小于3cm 肿瘤下缘距离括约肌间沟大于1cm 无外括约肌或提肛肌侵犯 Huashan Hospital Hao Hankun 括约肌间切除(ISR) 括约肌间切除（intersphincteric resection, ISR) 最早(1994)由Schiessel等详细描述 提高保肛率 获得更确切的下切缘 潜在的劣势： 增加手术并发症 局部复发 控便功能损害 Br J Surg. 1994 Sep;81(9):1376-8. Huashan Hospital Hao Hankun ISR评价 Dis Colon Rectum 2005; 48: 1858–1867 Intersphincteric resection is a valuable procedure for sphincter-saving rectal surgery. We showed that this technique has satisfactory long-term results in functional and oncologic respects. Huashan Hospital Hao Hankun ISR评价 Oncological outcomes after ISR for low rectal cancer are acceptable, with diverse, often imperfect functional results. These data will aid the clinician when counselling patients considering an ISR for management of low rectal cancer. British Journal of Surgery 2012; 99: 603–612 Huashan Hospital Hao Hankun ISR分类 Dis Colon Rectum 2009; 52: 64-70 Huashan Hospital Hao Hankun 选择ISR需谨慎 肿瘤分期 基础括约肌功能 是否需要辅助放疗 患者性别以及年龄 患者主观意愿 Huashan Hospital Hao Hankun APR指征 APR适用于肿瘤侵犯外括约肌或提肛肌，或可能导致肛门失禁的保肛术。 Huashan Hospital Hao Hankun 直肠癌手术原则 肿瘤学良好的结果 良好的功能保护 不要盲目保肛 Huashan Hospital Hao Hankun 手术视频 腹腔镜低位直肠癌根治（LAR） 1 Huashan Hospital Hao Hankun 复旦大学附属华山医院 蒿汉坤 haohankun@ * * Company Logo 腹腔镜辅助结直肠癌根治术 复旦大学附属华山医院 蒿汉坤 haohankun@ 主要内容 腹腔镜结直肠癌根治是否可行？ 1 如何行腹腔镜