colorectal surgery腹腔镜结直肠癌手术课件

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1、LaparoscopicColorectalSurgeryJanePBHendricksBsc(hons).SurgicalCarePractitionerLaparoscopicSurgery.ColchesterGeneralHospital.History1982SemmperformedfirstLaparoscopicAppendicectomy1987MouretperformedfirstLaparoscopicCholecystectomy1992FirstUKLaparoscopicTrainingcentresestablishedOperationsPe

2、rformedLaparoscopicallyIleo-colicresectionSegmentalcolectomy/anteriorresectionoftherectumforcancerSegmentalcolectomyforbenigndiseaseRectopexyAdvantagesanddisadvantagesofthelaparoscopicapproachSmallerwoundsLesspainFasterrecoveryTeaching/auditPortsiterecurrenceOncologicalmarginsCostLongeroper

3、ationLearningcurve‘Offcamera’injuryLongtermoutcomedataAdvantages–ImmuneResponseOpensurgeryrelatedimmunosuppressionwasassociatedwithincreasedtumourgrowthAllendorfJDetal.Increasedtumourestablishmentandgrowthafteropenvslaparoscopicsurgeryinmicemayberelatedtodifferencesinpost-operativeT-cellfun

4、ction.SurgEndosc1999;13:233-235PostoperativeplasmafrompatientsundergoingopenoperationsstimulatedgrowthoftheHT-29humancoloncancercellline.ThemagnitudeoftheeffectcorrelatedwithincisionlengthandlaparoscopicsurgerywasnotassociatedwithsuchchangesKirmanetal.Plasmafrompatientsundergoingmajoropensu

5、rgerystimulatesinvitrotumourgrowth:lowerinsulin-likegrowthfactorbindingprotein3levelsmay,inpart,accountforthischange.Surgery2002;132:186-192Portsiterecurrence–recentresults30/3547(0.85%)WittichPetal.(2000)Portsiterecurrencesinlaparoscopicsurgery.In:KockerlingF.Portsiteandwoundrecurrencesinc

6、ancersurgery.Heidelberg.Springer-Verlagpp12-2011/1114(1%)ChapmanAEetal.(2001)Laparoscopicassistedresectionofcolorectalmalignanciesasystemicreview.AnnSurg234:590-606Strasbourgserieshas0%in1000casesItalianregistryreported0.9%in1753casesTotalinhospitalcosts$9811vs$11,207Musseretal.Laparoscopic

7、colectomy:atwhatcost?SurgLaparoscEndosc19944:1-5Takeslonger1055patients(allrandomised)showedincreaseof20–60%intimeofoperationAbrahamNSetal.(2004)Meta-analysisofshort-termoutcomesafterlaparoscopicresectionforcolorectalcancer.12RCT’s2512patientsAdequatecle