当浆膜外科遇见黏膜外科：消化外科的机遇与挑战

When serosa surgery meets mucosa surgery： challenges andopportunities for digestive surgery

由于内镜和介入技术的进步，一部分传统上需要外科治疗的疾病，已经逐渐被内镜和介入治疗取代。“手术”本身已不再是外科医师的专属。外科学科的概念也因此而被重新定义。尽管有着相同的外科专业特质：切除和修复，但由于治疗路径不同而分化成两个不同的“外科”。以开放或腹腔镜为平台经体腔和脏器浆膜面入路的传统外科称之为“浆膜外科”；以内镜为平台从自然腔道黏膜面入路的内镜外科，称之为“黏膜外科”。当前学科交叉、渗透、技术融合是发展趋势。传统意义的学科或许将不复存在，取而代之的是以疾病为中心的多学科、多种技术联合的医疗模式。面临挑战，消化外科医师要有自信和包容；面对竞争，消化外科医师要勇于创新和合作，始终将患者获益放在首位。建立基于循证医学基础上的跨学科规范，学科间相互学习，优势互补，创建以疾病为中心的多学科融合新型诊断与治疗模式是消化外科发展方向。

With the developments of endoscopic and interventional techniques, the role of surgical treatment in some diseases is gradually replaced by endoscopic or interventional treatment. The word ＂surgery＂ may not preserve only for sur- geons, therefore it is redefined. According to different interven- tional pathways, digestive surgery can be divided into two cate- gories, although both are with similar surgical essentials as resection and repair. ＂ Serosa surgery＂ is traditional surgery, characterized for its pathway from skin to visceral serosa and cavity, either by open or laparoscopic platform. ＂ Mucosa surgery＂ performs endoscopic operations from natural orifice then mucosa surface. The intercrossing or merging of different disci- plines is an inevitable trend for modern medical science, tradi- tional disciplines may be replaced by disease-centered medical model combined with multiple disciplines and techniques. Facing challenges, digestive surgeons should be confidential and inclusive; facing competitions, digestive surgeons should be brave enough for innovation and cooperation, and always regard patients＇ interest as his first priority. A universal norm for vari- ous disciplines should be set up on the practice of evidence- based medicine; surgeons in different specialties should learn from each other, and reinforcing comple-mentary advantages from each other; creating a novel disease-centered multidiscipli- nary healthcare model on the basis of fusion of different disci- plines is the development direction of digestive surgery.