胃肠外科微创新技术的评价与卫生经济学思考  

Evaluation of new minimally invasive techniques in gastrointestinal surgery and contemplation on health economics

作　　者：王锡山[1] 

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院结直肠外科,100021

出　　处：《中华胃肠外科杂志》2017年第7期758-762,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目（81572930）;国家重点研发计划精准医学研究专项（2016YFC0905300）;中国医学科学院医学与健康科技创新工程项目（2016-12M-1-001）

摘　　要：随着1987年腹腔镜胆囊切除手术使微创外科这一名词被学界广泛知晓．普通外科的发展方向发生了改变，更依赖科学技术日新月异的进步。全世界范围内微创技术的创新如雨后春笋般涌现，如3D腹腔镜、经自然腔道、机器人手术等。它们可能具有相似的优势却又各不相同。尽管这些新技术还需要时间的考量，但我们需认识到这是任何新技术发展的必经之路。没有任何一种技术能够包治百病，所以我们不能够求全责备，要对创新报以开放的态度。但同时我们更应谨慎，在临床上切忌夸大某一技术的优点，轻视其弊端，只有把握好了适应证与禁忌证，才能让患者受益。在追求微创理念的道路上，作为外科医生，我们应该依靠先进的医学理念、技术及设备，在对患者有益的前提下，在规范中创新、在创新中务实、在务实中求真、在求真中前行。本篇笔谈从微创的历史开始追寻，并从各个角度及细节评价了一些胃肠外科的微创新技术，同时对卫生经济学意义进行了讨论与思考，意在为读者提供一些对于胃肠外科微创新技术的新的想法与思考，最终目的是令患者受益。With the widespread introduction of minimally invasive surgery （MIS） in late 1987 by laparoscopic cholecystectomy, the practice and expectation of general surgery were changed forever. As the development of scientific technology, new techniques of MIS have sprung up all around the world. 3D laparoscopy surgery, natural orifice transluminal endoscopic surgery, da Vinci surgical system and other new technologies also need time to be verified, and this is the only way all new things should get though. They are very unique in their own right, and all have advantages and disadvantages. None of them is the best, but all of them can be the most suitable technology for a single patient, so we should keep an open mind instead of judging too much. At the same time we should be cautious, but do not exaggerate the advantages and obscure the drawbacks. Identifying the indications and the contraindications is the only way we can benefit the patients. In the pursuit of MIS ideas, as a surgeon, we should rely on advanced medical concepts, technology and equipment, under the premise of being beneficial to the patients, innovating in the norms, practicing in the innovation, seeking the truth in the practice, and moving on forever. In this chapter, author illustrates the history of MIS, evaluates some new gastrointestinal MIS techniques from various angles and makes some discussions on health economics, on purpose to offer some new understandings of new gastrointestinal MIS techniques, eventually benefiting the patients.

关 键 词：胃肠外科 微创外科 新技术 卫生经济学 

分 类 号：R1[医药卫生—公共卫生与预防医学] R656