提高腹腔镜结直肠手术安全性的关键技术环节  

Key techniques for enhancing the safety of laparoscopic colorectal surgery

作　　者：郑民华[1] 赵轩[1] ZHENG Min-hua;ZHAO Xuan(Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Minimally Invasive Surgery Center,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科胃肠外科上海市微创外科临床医学中心,上海200025

出　　处：《中国实用外科杂志》2025年第1期65-68,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82072614);上海创新医疗器械应用示范项目(No.23SHS03000)。

摘　　要：腹腔镜结直肠手术经过三十余年的发展,现已达到技术相对成熟的阶段,其安全性和有效性在临床实践中得到了广泛验证。然而,随着新辅助治疗(如放化疗、靶向免疫治疗)的普及以及机器人辅助手术、3D腹腔镜、减孔或单孔手术等新技术的应用,对手术操作细节的要求逐渐提高,增加了手术复杂性。为了确保手术的安全性和效果,必须从多个方面把握关键技术环节。文章从术前评估及手术指征的把握、手术的肿瘤根治、手术操作要点及关键技术、中转开放手术的时机、术后的观察和处理等方面论述了提高腹腔镜结直肠手术安全性的关键环节及要点。提高腹腔镜结直肠手术的安全性和质量依赖于细致的术前准备、精准的术中操作和周密的术后护理,最终目的是为病人提供更加安全有效的医疗服务。After more than three decades of development,laparoscopic colorectal surgery has reached a relatively mature technical stage.Its safety and efficacy have been extensively validated in clinical practice.However,with the widespread adoption of neoadjuvant therapies(such as chemoradiotherapy and targeted immunotherapy)and the application of new technologies like robotic-assisted surgery,3D laparoscopy,reduced-port or single-port surgery,and transanal specimen retrieval,the requirements for surgical operational details have become increasingly stringent,thereby increasing the complexity of procedures.To ensure the safety and effectiveness of laparoscopic colorectal surgery,it is imperative to focus on multiple key technical aspects.This article discusses these critical elements from several perspectives:preoperative assessment and indication selection,oncological radicality of the surgery,operative techniques and key technologies,timing for conversion to open surgery,and postoperative observation and management.The enhancement of safety and quality in laparoscopic colorectal surgery hinges on meticulous preoperative preparation,precise intraoperative execution,and comprehensive postoperative care.The ultimate goal is to provide patients with safer and more effective medical services.By addressing these key areas,surgeons can better navigate the challenges posed by evolving treatment paradigms and technological advancements,ultimately improving patient outcomes.

关 键 词：腹腔镜 结肠癌 直肠癌 手术安全 

分 类 号：R6[医药卫生—外科学]