鎖孔(腹腔鏡)結直腸手術

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鎖孔手術具有縮小手術創口大小的益處,從而可以減少美觀方面的困擾並且減少病人的疼痛。這使患者由於疼痛減少可以儘早活動,從而儘早恢復正常生活包括儘早返回工作崗位。

圖例1. 鎖孔手術開出小型創口以便使得攝像機及儀器進入,因此避免更大的手術創口產生

鎖孔(內窺鏡)手術現在已經在多次隨機對照試驗[1-8]中顯示對於結腸癌手術的使用是安全的。大量隨機對照試驗及大規模回顧研究[9]都十分類似,已經證明其對於直腸癌手術具有益處。兩個大型澳大利亞研究已經顯示該手術方法對於結直腸癌症的安全性,並且對於年幼及年老患者的益處[10-11]。

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機器人手術是一種新興技術,結合了微創手術及只有機器人才能提供的高度精密準確性。該方法最為有用的應用是針對那些位於骨盆較低處的手術,使其尤其適合用於低位直腸癌症手術。該方法提供腹腔鏡手術的諸多益處,並且還改善操控性從而實現更好的切除邊緣,帶來更少的失血。

按此預約結直腸外科醫生

References

1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718-1726.

2. Araujo SE , da Silva eSousa AH Jr, dr Campos FG, et al. Conventional approach laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sau Paulo. 2003;58:133-40.

3. Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 2008;15:2418-2425.

4. Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004;363:1187-1192.

5. Kang S et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010;11:637-645.

6. Zhou Z, Hu M, Li Y, et al. Laparoscopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 2004;18:1211-1215.

7. Braga M, Frasson M, Vignali A, et al. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 2007;50:464-471.

8. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 2009;96:982-989.

9. Breukink S, Pierie JP, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005200. DOI: 10.1002/14651858.CD005200.pub2.

10. Allardyce RA, Bagshaw PF, Frampton CM, et al. The Australasian laparaoscopic colon cancer study. ANZ J Surg. 2008;78:832–833.

11. McKay GD, Morgan MJ, Wong SKC, et al. Improved Short-term Outcomes of Laparoscopic versus Open Resection for Colon and Rectal Cancer in an Area Health Service: A Multicentre Study. Diseases of the Colon & Rectum 2012: 55(1); page 42-50.