解剖学微创向功能学微创的转变

Transition from anatomic to functional minimally invasive surgery

外科史上有3次伟大的飞跃，第1次是1906年Carrel完成了微小血管吻合，为现代血管外科和移植外科奠定了基础，1912年他因此获得诺贝尔奖；第2次是1954年Murrey完成了同卵双生兄弟间肾移植，从此揭开了器官移植的篇章；第3次是1987年法国妇产科医师Mouret完成了第1例LC，从而拉开了微创外科的帷幕。

With the development of minimally invasive management, laparoscopic operation has become more and more prevalent. As a surgical procedure, a serial of events, such as psychological damage, fasting, bleeding, hypothermia, pain, introduce of cathartic, gastric tube, urinary catheter and aggres- sive resuscitation of crystal fluid, can produce stress and delay the rehabilitation. Evidence-based medicine has demonstrated that during the laparoscopic surgery, alleviating these events is associated with milder stress reaction and fast recovery. The fo- cus of minimally invasive surgery should be shifted from the local injury to the stress of the whole body, from the wound size to the psychological, physiological and pathological changes of the whole body, from the technique of operation to the comprehen- sive management during perioperative period. In summary, the minimally invasive surgery focuses more and more on minimizing the stress influence on the whole body rather than merely on the minimal incision. It is reasonable to conclude that this kind of research will bring significant innovation in minimally invasive surgery in the future.