结直肠肿瘤微创手术的历史演变与终极目标

Historical evolution and ultimate goal of minimally invasive surgery for colorectal cancer

微创结直肠外科手术出现至今仅30余年时间。与传统开放手术相比,微创手术具有创伤小、操作精细和术后恢复快等优点。目前,微创结直肠肿瘤手术无论从手术入路、手术平台或手术方式上均呈多元化延伸的趋势。此外,规范化的综合治疗与免疫治疗对微创外科的发展产生了深远影响。而围手术期并发症的诊治仍是今后微创外科研究的另一重要议题。随着人们对生活质量的追求,患者除了关注近期疗效外,更加注重永久疗效,包括长期生存和良好的排粪排尿及性功能,这也是微创外科追求的终极目标,即永久微创。为达到这一美好愿景,我们必须努力纠正不当的治疗方式;理性地选择新兴手术入路和手术平台的适宜人群;更加重视和强调肿瘤的综合诊疗;尤其在以患者安全为中心的基础上,审慎开展新技术的研究。

Minimally invasive colorectal surgery has been an entity for just over 30 years.Compared with traditional open surgery,minimally invasive surgery has the advantages of less trauma,more delicate operation and faster postoperative recovery.At present,minimally invasive surgery for colorectal tumor shows a diversified trend in terms of surgical approach,surgical platform or surgical methods.Besides,standardized comprehensive treatment and immunotherapy have had far-reaching impacts on the development of minimally invasive surgery.The diagnosis and treatment of perioperative complications is still another important topic in the research of minimally invasive surgery in the future.In addition to the short-term outcomes,the most important thing that patients truly require and emphasize is the permanence of the curative effect,that is,long-term survival and good defecation,urination and sexual function.Thus,permanence is the ultimate goal of minimally invasive surgery.To achieve this,we should strive to correct improper treatment methods,rationally select applicable groups of emerging surgical approaches and surgical platforms,pay more attention to comprehensive tumor diagnosis and treatment,and prudently carry out new technology research on the basis of the basic concept of patient safety.