laparoscopic colorectal surgery：腹腔镜结直肠癌手术

《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