“隐瘢痕”手术的临床应用进展

Progress in clinical application of scar-hidden endoscopic surgery

目的与传统开腹手术相比,在手术效果相同、手术安全得到保证的前提下,腹腔镜手术不仅术后瘢痕得到极大缩小,在手术时间、术中出血、术后患者恢复、住院时间等方面亦有优势,使得腹腔镜技术逐渐取代开腹手术成为多数腹部手术的主流选择.尽管腹腔镜术后腹壁仅留下3？5个5？10mm的手术瘢痕,但人类对术后腹壁美容的追求使得“无瘢痕”和“隐瘢痕”手术成为新的研究热点.经自然腔道内镜手术（NOTES）的出现将腹壁无瘢痕的腔镜手术推到极致,但是NOTES手术本身存在-些伦理及技术的问题使得它尚未能真正在临床广泛开展.方法既能达到NOTES技术美容效果的同时,又可以减低手术难度及术后并发症的风险,使得“隐瘢痕”（SHES）手术应运而生.SHES的思想体现在：①转移常规腹腔镜手术切口位置：经白线入路,即将切口分别隐藏于脐部和白线处;经纹身入路,切口分别隐藏于脐部和纹身处;经既往搬痕入路,将切口分别隐藏于脐部和既往瘢痕处;经体毛入路,切口分别隐藏于脐部和阴毛内;②缩小常规腹腔镜手术切口;③减少常规腹腔镜手术的切口数量;④减少常规免气腹腹腔镜手术的腹壁切口损伤.结果临床6万例患者“隐瘢痕”手术的成功实践和患者的良好反馈显示,与常规腹腔镜手术相比,我们开展的几种“隐瘢痕”手术,各指标稍优于或与常规腹腔镜手术相近,但具有更好美容效果.结论全国多家合作医院的手术应用也验证了SHES的可行性和安全性,在临床治疗中得到广泛应用.

OBJECTIVE Compared with the traditional open surgery, under the premise of the same of operation safety and operation effectis guaranteed,the advantages of laparoscopic surgery include not only less postoperative scar,shorter operation time and less bleeding during surgery but also faster postoperative recovery and shorter hospital stay. Accordingly,the open surgeryhas been gradually replaced by laparoscopic surgery which has become the mainstream choice of abdominal surgery.However, although the scar length isonly 5~10 mm and number of scars are less 3 by laparoscopic technology, the endless pursuit cosmetology of the patients makes Hno scar＂ and ＂hidden scarM surgery becoming a new research focus.The emergence of NOTES push the scarless abdominal laparoscopic technology to the extreme, but there are some ethical and technical problems in the technology of NOTES, which does not make it widely being carried out in clinical practice.METHODS Actually, not only achieve the beauty effect of NOTES technology but also reduce the operation difficulty and therisk of postoperative complications promotesSHES technology come into being. The mechanism of SHES is reflected in： ① The transfer of conventional laparoscopic surgery incisionposition：the linea alba approach （ the incisions are hidden in the linea alba）; the tattoo approach （ the incision is hidden in the ximbilical and the tattoo）; previous scar approach （the incision was hidden in the ximbilical and previous scar）;the pubesapproach （the incision was hidden in the umbilical and pubes）; ② Reduction of conventional laparoscopic abdominal incision length; ③ Reducing number of conventional laparoscopic surgery incision;④ To reduce the damage of conventional abdominal incision of gasless laparoscopic surgery.RESULTS The successful practice of ＂SHES＂ surgery in 60 thousand patients and good feedback of patients, compared with conventional laparoscopic surgery, extremely proved the success of SHES technology which hasnot only better cosmetic resultsbut alsoslightly superior or similar of operation safety and operation effect to the conventional laparoscopic technology.CONCLUSION The feasibility and safety of SHES were verified by the practice of numbers of cooperative hospitals and ＂SHES＂ technology hasbeen widely used in clinical treatment around the country.