胃肠微创外科临床研究2017年盘点及未来展望

Review of clinical investigation in minimally invasive gastrointestinal surgery in 2017 and future prospects

胃肠微创外科在2017年进入了临床研究突飞猛进的一年。从戳孔、手术入路、淋巴清扫、消化道重建、全腔镜手术、免切口手术、3D腹腔镜、机器人手术等系列的手术规范逐步建立。在胃癌治疗领域，腹腔镜技术治疗进展期胃癌的一手数据即将发布。研究热点也逐渐转移至进展期胃癌的淋巴结清扫、切除范围和消化道重建等。在结直肠癌治疗领域，腹腔镜结肠癌手术清扫范围（完整结肠系膜切除和D，根治）及不同手术入路持续成为研究热点；腹腔镜在直肠癌中安全应用受到循证医学证据的挑战，激起了腹腔镜结直肠外科医师对于腹腔镜直肠癌手术肿瘤学根治性的进一步研究热潮；特别值得提出的是，作为一种新的手术入路，经肛全直肠系膜切除手术相关研究成为结直肠外科领域今年当之无愧的重点与热点。最后，在胃肠微创外科新器械的相关研究中，国产化3D腹腔镜系统、腹腔镜智能机械臂及手术机器人的研发也是2017年的研究重点。综上所述，以腹腔镜为代表的微创外科经过30多年的发展，在胃肠道手术领域已经日趋成熟，但是仍有很多临床问题亟待解决，未来微创外科发展方向将主要集中于传统微创术式的规范化、新微创术式的研发、微创相关数字设备与新技术研发。

Clinical investigation in minimally invasive gastrointestinal surgery has been developed by leaps and bounds in 2017. Standardizations of port placement, surgieal approaches, lymphadenectomy, reconstruction, total laparoscopie surgery, ineision-free technique, 3D laparoscope, as well as robotic surgeries, have been established. In the treatment for gastric cancer, the first-hand data of the laparoscopic technique for advanced gastrie caneer will be released soon. Therefore, the research hotspots have been moved forward to lymphadenectomy, resection range, and reconstruction in laparoscopic advanced gastrie cancer surgery. In the treatment for eoloreetal cancer, the lymphadeneetomy range （eomplete colorectal excision and D3） and the effect of various of surgical approaehes persistently become the research areas in laparoscopic colon cancer surgery. While the research interest of laparoseopic rectal cancer surgery still focus on the ontological effeet evaluation of laparoscopic technique, duo to the recent evidence-based data challenging the usage of laparoscopic technique in rectal cancer treatment. What worth to notice is that trans-anal total mesorectal excision, as a new surgical approach, has undoubtedly become the most popular research field in 2017. Last but not least, the domestication of 3D instrument, laparoscope positioning robot, and surgical robot are the pop areas in the surgical instrument and equipment innovation area. In a word, with the 30-year development of minimally invasive surgery, represented by laparoscopic technique, it has become a mature technology, but still with some burning questions. The future trends of clinical investigations will focus on standardization of traditional laparoscopie techniques, development of new laparoseopic techniques, as well as the development of innovative digital equipments and instruments.