中国腹腔镜直肠癌根治术30年来的巨大进步

The tremendous progress in laparoscopic radical surgery for rectal cancer over the past three decades in China

回顾近30年,腹腔镜直肠癌根治手术在中国发展经历了从安全性和可行性探索,手术质量控制体系的建立,功能性根治手术及操作流程的标准化,以及新辅助治疗和保直肠策略的进步。首先,腹腔镜在直肠癌根治手术的证据级别逐渐提高,从安全性和可行性探索逐步走向治疗规范化。随着膜解剖理念的发展和亚微外科的进步,腹腔镜直肠癌手术操作流程更加标准化,保护器官功能和提高远期生命质量成为直肠癌治疗的重要目标。其次,随着科学技术和综合治疗的进步,进展期直肠癌腹腔镜手术逐渐突破禁忌,实现巨创手术微创化、手术入路多样化、手术方式个体化。随着低位直肠癌的新辅助治疗进步,严格把握适应证的保直肠治疗策略,在保证肿瘤学疗效的同时进一步提高患者生命质量,实现低位直肠癌去外科化。本文将从外科安全、肿瘤根治和功能保留等方面,结合笔者实践,对近30年我国腹腔镜直肠癌根治手术的巨大进步进行了总结分析。

Over the past three decades,the development of laparoscopic radical surgery for rectal cancer in China has undergone a progression from exploring safety and feasibility to establishing a quality control system for surgery,standardizing functional radical surgery and procedural operations,and advancing in neoadjuvant therapy and rectum-preserving strategies.Firstly,the evidence level of laparoscopy in rectal cancer radical surgery has gradually increased,transitioning from exploration of safety and feasibility to standardized treatment protocols.Secondly,with the development of mesorectal anatomy and advancements in minimally invasive surgery,the procedural operations of laparoscopic rectal cancer surgery have become more standardized,with the preservation of organ function and improvement of long-term quality of life becoming important goals in rectal cancer treatment.Thirdly,with the progress of science and technology and comprehensive therapy,laparoscopic surgery for advanced rectal cancer has gradually overcome prohibitions,achieving minimally invasive surgery for extensive operations,diversifying surgical approaches,and individualizing surgical methods;along with the advancement of neoadjuvant therapy for low rectal cancer,strictly adhering to indications for rectum-preserving treatment strategies,further improving patient quality of life while ensuring oncological efficacy,and realizing non-surgical treatment for low rectal cancer.This article will summarize and analyze the tremendous laparoscopic radical surgery for rectal cancer over the past three decades in China,including surgical safety,oncological eradication,and functional preservation,based on the author's practice.