Laparoscopic Colorectal Surgery：腹腔镜结直肠癌手术.ppt

Laparoscopic Colorectal Surgery Jane P B Hendricks Bsc(hons). Surgical Care Practitioner Laparoscopic Surgery. Colchester General Hospital. History 1982 Semm performed first Laparoscopic Appendicectomy 1987 Mouret performed first Laparoscopic Cholecystectomy 1992 First UK Laparoscopic Training centres established Operations Performed Laparoscopically Ileo-colic resection Segmental colectomy/ anterior resection of the rectum for cancer Segmental colectomy for benign disease Rectopexy Advantages and disadvantages of the laparoscopic approach Smaller wounds Less pain Faster recovery Teaching/audit Port site recurrence Oncological margins Cost Longer operation Learning curve ‘Off camera’ injury Long term outcome data Advantages – Immune Response Open surgery related immunosuppression was associated with increased tumour growth Allendorf JD et al. Increased tumour establishment and growth after open vs laparoscopic surgery in mice may be related to differences in post-operative T-cell function. Surg Endosc 1999;13:233-235 Post operative plasma from patients undergoing open operations stimulated growth of the HT-29 human colon cancer cell line. The magnitude of the effect correlated with incision length and laparoscopic surgery was not associated with such changes Kirman et al. Plasma from patients undergoing major open surgery stimulates in vitro tumour growth: lower insulin-like growth factor binding protein 3 levels may, in part, account for this change. Surgery 2002;132:186-192 Port site recurrence – recent results 30 / 3547 (0.85%) Wittich P et al. (2000) Port site recurrences in laparoscopic surgery. In: Kockerling F. Port site and wound recurrences in cancer surgery. Heidelberg. Springer-Verlag pp 12-20 11/1114 (1%) Chapman AE et al. (2001) Laparoscopic assisted resection of colorectal malignancies a systemic review. Ann Surg 234:590-606 Strasbourg series has 0% in 1000 cases Italian registry reported 0.9% in 1753 cases Total in hospita