我國(guó)普外腹腔鏡手術(shù)的發(fā)展

1、啟動(dòng)快的原因,人的因素 對(duì)腹腔鏡手術(shù)的反應(yīng)敏感，認(rèn)識(shí)和承認(rèn)它的優(yōu)點(diǎn)，積極熱情，愿為發(fā)展腹腔鏡手術(shù)而盡力。在腹腔鏡的發(fā)展過(guò)程中克服多種困難，成為推進(jìn)我國(guó)腹腔鏡發(fā)展的骨干。腹腔鏡手術(shù)確有微創(chuàng)優(yōu)點(diǎn)公司的支持,停滯階段,1995-1999 醫(yī)院增多，手術(shù)種類減少原因 技術(shù)不成熟，中途放棄 結(jié)腸癌術(shù)后傷口種植 缺乏有效的和適用的器械

2、 公司支持減少 國(guó)民經(jīng)濟(jì)尚不充裕,大發(fā)展,,1999- 第一屆外科周介紹和認(rèn)識(shí)了腹腔鏡超聲刀 1997 國(guó)內(nèi)用腹腔鏡超聲刀做膽囊切除、結(jié)腸切除 1998 國(guó)內(nèi)用腹腔鏡超聲刀做腎上腺切除、脾切除 技術(shù)成熟、經(jīng)驗(yàn)豐富教學(xué)醫(yī)院和專業(yè)醫(yī)院的開(kāi)展、專業(yè)醫(yī)生的加入微創(chuàng)優(yōu)點(diǎn)得到承認(rèn)經(jīng)濟(jì)情況好轉(zhuǎn),現(xiàn)狀,腔鏡甲狀腺切除 病種: 甲狀腺瘤、結(jié)節(jié)性甲狀腺腫、甲狀腺

3、機(jī)能亢進(jìn)、甲狀腺癌，甲狀旁腺腫瘤。 手術(shù)：甲狀腺部分切除、甲狀腺次全切除、一葉全切一葉部分切除，甲狀旁腺切除，甲狀腺再次手術(shù)。 手術(shù)入路; 雙乳暈胸前、胸前、腋下、腋乳,現(xiàn)狀,腹腔鏡肝臟手術(shù) 腹腔鏡肝囊腫開(kāi)窗術(shù)、肝包囊蟲(chóng)的腔鏡治療 肝切除術(shù) 病種：肝癌、血管瘤、結(jié)石、囊腫、膿腫等。 術(shù)式： 楔形切除、肝葉切除、左半肝切

4、除、右半肝切除， 完全氣腹，手助。 器械：超聲刀、智能雙極電凝刀（Ligasur,PK刀），刮吸刀，螺旋水刀，HWD-2型腹腔鏡專用微波刀，鈦夾，Endo GIA,等。 效果：近期好，轉(zhuǎn)開(kāi)腹，并發(fā)癥，遠(yuǎn)期？ 上海、廣州、北京、杭州、桂林、南通、武漢、濟(jì)南、福州,現(xiàn)狀,膽道外科 腹腔鏡膽囊切除 腹腔

5、鏡膽總管切開(kāi)取石 腹腔鏡膽總管囊腫切除術(shù) 膽腸吻合術(shù) 膽道腫瘤？,現(xiàn)狀,胰腺手術(shù) 假性胰腺囊腫胃吻合術(shù)、腸吻合術(shù) 胰體尾切除術(shù)（?；虿槐Ｆⅲ?胰島細(xì)胞瘤切除術(shù) 胰十二指腸切除術(shù) 胰頭或壺腹周圍的小腫瘤，胰空腸端端吻合（縫或捆綁），胰胃吻合，南寧、上海、杭州、南京、廣州、等。,現(xiàn)狀,腹腔鏡脾臟手術(shù) 病脾切除：

6、 血液病、脾囊腫、脾膿腫、脾臟脈管瘤，等。 外傷脾修補(bǔ)術(shù)。 門脈高壓巨脾切除、門奇斷流手術(shù)。 手助，改良Sugiura手術(shù),現(xiàn)狀,腹腔鏡胃手術(shù) 胃良性腫瘤切除術(shù)、胃良性疾病切除、穿孔縫合術(shù)。迷走神經(jīng)切斷術(shù)。食管旁裂孔疝修補(bǔ)術(shù)，減肥手術(shù)，抗反流胃底折疊術(shù)。 胃癌根治術(shù)

7、 完全氣腹、腹腔鏡輔助下、手助腹腔鏡胃癌根治術(shù)。 上海、重慶、廣州、南寧、溫州 、北京等,現(xiàn)狀,腹腔鏡結(jié)腸手術(shù) 是較成熟和開(kāi)展較多的手術(shù) 良性病變：家族息肉病、潰瘍性結(jié)腸炎、便秘、結(jié)腸息肉 結(jié)腸癌：左或右半結(jié)腸切除、橫結(jié)腸切除 結(jié)直腸癌：TME。Dixon手術(shù), 保肛低位吻合，Miles手術(shù) 。

8、 技術(shù)比較成熟，微創(chuàng)優(yōu)點(diǎn)已獲承認(rèn)，治療效果亦得證實(shí)。國(guó)內(nèi)尚缺循證醫(yī)學(xué)資料。,現(xiàn)狀,其他腹腔鏡在小腸腫瘤診治中的應(yīng)用腹腔鏡在治療粘連性不全腸梗阻的應(yīng)用乳腺癌腔鏡下保乳和腋下淋巴結(jié)廓清術(shù)腹腔鏡疝修補(bǔ)術(shù)：斜疝、直疝、切口疝、食道裂孔疝、造口旁疝。腹腔鏡在急腹癥、腹部外傷病人中的應(yīng)用,存在問(wèn)題和發(fā)展方向,嚴(yán)格掌握適應(yīng)癥，防止誤診和漏診 腹腔鏡手術(shù)不同于開(kāi)腹手術(shù)，不能觸摸探查。術(shù)前需做好診斷和鑒別診斷。是否需要手術(shù)？

9、 需要做那種手術(shù)？術(shù)式按先進(jìn)標(biāo)準(zhǔn)進(jìn)行，不能自己會(huì)甚麼就做甚麼。 特別是腫瘤根治手術(shù) 提高認(rèn)識(shí)和技術(shù)水平，減少并發(fā)癥發(fā)生。努力提高腹腔鏡手術(shù)的治療效果，才能發(fā)展和推廣腹腔鏡手術(shù),存在問(wèn)題和發(fā)展方向,腹腔鏡手術(shù)處于可行性的探索階段，目前是手術(shù)技術(shù)的改革或革命。一旦手術(shù)定型，就應(yīng)研究腹腔鏡手術(shù)與開(kāi)腹手術(shù)引起身體生理變化的異同，以及有關(guān)的術(shù)前準(zhǔn)備和術(shù)后處理。這樣才能形成完美的微創(chuàng)外科體系。注意循證醫(yī)學(xué)的研究

10、多中心、大規(guī)模、前瞻性、隨機(jī)雙盲臨床評(píng)價(jià)研究。 成立專題組，聯(lián)合、互助、共同提高,感謝各位的參與,祝各位事業(yè)成功,The Development of General Laparoscopic Surgery In China,Department of Surgery, First Hospital, Peking University

11、 Guoli Liu,Initial Stage,1991-1994 The development of LS in China was started later but the progression was fast 1991-2 laparoscopic cholecystectomy 1993 laparoscopic gastrectomy

12、 laparoscopic colectomy laparoscopic choledochotomy 1994 laparoscopic hepatectomy laparoscopic splenectomy,Why the progression was fast,Int

13、erpersonal factors Sensitive, positive and enthusiastic to LS, recognized the advantage of LSLaparoscopic surgery is actually minimally invasive surgeryCompany supports,Stagnant,1995-1999 Hospitals carrie

14、d out LS were increasing, but the kind of operations were decreasing.Causes1 Technique is still Immature, 2 Postoperative port site recurrence of laparoscopic colorectal surgery3 Lack effective、suitabl

15、e instruments4 company supports reducedPlentiful GDP further expansion are expected,Great development,1999—— introduction and well-known ultrasonic scalpel on ’99- Beijing Surgical Week 1997 laparoscop

16、ic cholecystectomy laparoscopic colectomy 1998 laparoscopic adrenalectomy laparoscopic splenectomy Mature technique, rich experience, specialized doctors .The advantage of L

17、S were recognized by doctors and patients The GDP continuously increasing 11 大發(fā)展1999- 第一屆外科周介紹和認(rèn)識(shí)了腹腔鏡超聲刀 1997 國(guó)內(nèi)用超聲刀作 腹腔鏡膽囊切除、結(jié)腸切除 1998 國(guó)內(nèi)用超聲刀作 腹腔鏡腎上腺切除、脾切除技術(shù)成熟、經(jīng)驗(yàn)豐富教學(xué)醫(yī)院、省立醫(yī)院和?？漆t(yī)院的

18、開(kāi)展以及專業(yè)醫(yī)生加入腔鏡手術(shù)的優(yōu)點(diǎn)得到承認(rèn)經(jīng)濟(jì)情況好轉(zhuǎn),Laparoscopic thyroidectmy,Kind of diseases thyroid tumor, nodular goiter, hyperthyroidism, thyroid carcinoma parathyroidomaOperations partial or subtotal thyroidectomy, parathyroid

19、ectomy, Entrances anterior thoracic wall, anterior axillary line, axillary-areola of mamma,Laparoscopic hepatic surgery,Fenestration for liver cystLaparoscopic treatment of hydatid cystHepatectomy Kind of disea

20、ses: hepatocelllular carcinama, hepatic hemangioma, hepatolithiasis, hepatic cyst, liver abscess Operations: hepatic wedge resection, lobectomy of liver, Complete laparoscope, Hand assistant. I

21、nstruments: ultrasonic scalpel, ligasure , new type of microwave knife, PMOD, water jet dissection, Endo GIA Shanghai, Guangzhou, Beijing, Hangzhou, Guilin, Nantong, Wuhan, Jinan, Fuzhou, et.,Laparosco

22、pic biliary tract surgery,Laparoscopic cholecystectomyLaparoscopic choledocholithotomyLaparoscopic resection of choledochoceleLaparoscopic choledochojejunostomy or cholecystojejunostomyTumor of biliary tract ?,Laparo

23、scopic pancreatic surgery,pancreatic pseudocystogastrostomy or pseudocystojejunostomyResection of pancrea bodylaparoscopic enucleation of pancreatic islet cell tumorsPancreatoduodenectomy peri ampulla carcinoma, pa

24、ncreaticojejunostomyNanning ,Shanghai,Hangzhou,Nanjing,Guangzhou,,Laparoscopic splenic surgery,Laparoscopic splenectomy ITP, splenic cyst, splenic abscess, splenic hemangioma, et al.Neoplasty of injured spleenP

25、ortal hypertension Hand assisted, splenectomy and pericardial devascularization, Sugiura operation,Laparoscopic surgery of stomach,Partial & subtotal gastrectomy for benign disease or tumorLaparoscopic repair

26、 for perforation of peptic ulcerLaparoscopic vagotomySurgical treatment of paraesophageal hiatal herniaLaparoscopic antireflux surgeryLaparoscopic gastric bandingCarcinoma of stomach Ⅰ、Ⅱ、Ⅲ stages，complete lap

27、aroscope, laparoscopic assisted , hand assisted.Shanghai,Chongqing,Guangzhou,Nanning,Wenzhou,Beijing, et al.,Laparoscopic colonrectal surgery,Are mature and common laparoscopic operationBenign diseases: familial intest

28、inal polyposis, ulcerative colitis, colic polyp.Carcinoma of colon left or right hemicolectomy, Rectal carcinoma TME, Dixon, miles. Good result ,minimally invasive surgery,Others,Laparoscopic surgery for small bowel