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ID:15177445
大小:1.85 MB
页数:32页
时间:2018-08-01
《laparoscopic colorectal surgery:腹腔镜结直肠癌手术》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、LaparoscopicColorectalSurgeryJanePBHendricksBsc(hons).SurgicalCarePractitionerLaparoscopicSurgery.ColchesterGeneralHospital.History1982SemmperformedfirstLaparoscopicAppendicectomy1987MouretperformedfirstLaparoscopicCholecystectomy1992FirstUKLaparoscopicTrainingce
2、ntresestablishedOperationsPerformedLaparoscopicallyIleo-colicresectionSegmentalcolectomy/anteriorresectionoftherectumforcancerSegmentalcolectomyforbenigndiseaseRectopexyAdvantagesanddisadvantagesofthelaparoscopicapproachSmallerwoundsLesspainFasterrecoveryTeaching
3、/auditPortsiterecurrenceOncologicalmarginsCostLongeroperationLearningcurve‘Offcamera’injuryLongtermoutcomedataAdvantages–ImmuneResponseOpensurgeryrelatedimmunosuppressionwasassociatedwithincreasedtumourgrowthAllendorfJDetal.Increasedtumourestablishmentandgrowthaf
4、teropenvslaparoscopicsurgeryinmicemayberelatedtodifferencesinpost-operativeT-cellfunction.SurgEndosc1999;13:233-235PostoperativeplasmafrompatientsundergoingopenoperationsstimulatedgrowthoftheHT-29humancoloncancercellline.Themagnitudeoftheeffectcorrelatedwithincis
5、ionlengthandlaparoscopicsurgerywasnotassociatedwithsuchchangesKirmanetal.Plasmafrompatientsundergoingmajoropensurgerystimulatesinvitrotumourgrowth:lowerinsulin-likegrowthfactorbindingprotein3levelsmay,inpart,accountforthischange.Surgery2002;132:186-192Portsiterec
6、urrence–recentresults30/3547(0.85%)WittichPetal.(2000)Portsiterecurrencesinlaparoscopicsurgery.In:KockerlingF.Portsiteandwoundrecurrencesincancersurgery.Heidelberg.Springer-Verlagpp12-2011/1114(1%)ChapmanAEetal.(2001)Laparoscopicassistedresectionofcolorectalmalig
7、nanciesasystemicreview.AnnSurg234:590-606Strasbourgserieshas0%in1000casesItalianregistryreported0.9%in1753casesTotalinhospitalcosts$9811vs$11,207Musseretal.Laparoscopiccolectomy:atwhatcost?SurgLaparoscEndosc19944:1-5Takeslonger1055patients(allrandomised)showedinc
8、reaseof20–60%intimeofoperationAbrahamNSetal.(2004)Meta-analysisofshort-termoutcomesafterlaparoscopicresectionforcolorectalcancer.12RCT’s2512patientsAdequatecle
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